|
047E06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E06Z
|
| Hospital Charge Code |
2154
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E07Z
|
| Hospital Charge Code |
2155
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E341
|
| Hospital Charge Code |
2156
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E34Z
|
| Hospital Charge Code |
2157
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E35Z
|
| Hospital Charge Code |
2158
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E36Z
|
| Hospital Charge Code |
2159
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E37Z
|
| Hospital Charge Code |
2160
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E441
|
| Hospital Charge Code |
2161
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E44Z
|
| Hospital Charge Code |
2162
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E45Z
|
| Hospital Charge Code |
2163
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E46Z
|
| Hospital Charge Code |
2164
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047E47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E47Z
|
| Hospital Charge Code |
2165
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F041
|
| Hospital Charge Code |
2166
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F04Z
|
| Hospital Charge Code |
2167
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F05Z
|
| Hospital Charge Code |
2168
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F06Z
|
| Hospital Charge Code |
2169
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F07Z
|
| Hospital Charge Code |
2170
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F341
|
| Hospital Charge Code |
2171
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F34Z
|
| Hospital Charge Code |
2172
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F35Z
|
| Hospital Charge Code |
2173
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F36Z
|
| Hospital Charge Code |
2174
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F37Z
|
| Hospital Charge Code |
2175
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F441
|
| Hospital Charge Code |
2176
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F44Z
|
| Hospital Charge Code |
2177
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047F45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047F45Z
|
| Hospital Charge Code |
2178
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
