|
047J36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047J36Z
|
| Hospital Charge Code |
2204
|
| 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
|
|
|
047J37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047J37Z
|
| Hospital Charge Code |
2205
|
| 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
|
|
|
047J441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047J441
|
| Hospital Charge Code |
2206
|
| 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
|
|
|
047J44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047J44Z
|
| Hospital Charge Code |
2207
|
| 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
|
|
|
047J45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047J45Z
|
| Hospital Charge Code |
2208
|
| 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
|
|
|
047J46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047J46Z
|
| Hospital Charge Code |
2209
|
| 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
|
|
|
047J47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047J47Z
|
| Hospital Charge Code |
2210
|
| 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
|
|
|
047K041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K041
|
| Hospital Charge Code |
2211
|
| 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
|
|
|
047K04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K04Z
|
| Hospital Charge Code |
2212
|
| 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
|
|
|
047K05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K05Z
|
| Hospital Charge Code |
2213
|
| 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
|
|
|
047K06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K06Z
|
| Hospital Charge Code |
2214
|
| 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
|
|
|
047K07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K07Z
|
| Hospital Charge Code |
2215
|
| 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
|
|
|
047K341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K341
|
| Hospital Charge Code |
2216
|
| 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
|
|
|
047K34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K34Z
|
| Hospital Charge Code |
2217
|
| 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
|
|
|
047K35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K35Z
|
| Hospital Charge Code |
2218
|
| 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
|
|
|
047K36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K36Z
|
| Hospital Charge Code |
2219
|
| 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
|
|
|
047K37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K37Z
|
| Hospital Charge Code |
2220
|
| 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
|
|
|
047K441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K441
|
| Hospital Charge Code |
2221
|
| 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
|
|
|
047K44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K44Z
|
| Hospital Charge Code |
2222
|
| 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
|
|
|
047K45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K45Z
|
| Hospital Charge Code |
2223
|
| 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
|
|
|
047K46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K46Z
|
| Hospital Charge Code |
2224
|
| 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
|
|
|
047K47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047K47Z
|
| Hospital Charge Code |
2225
|
| 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
|
|
|
047L041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L041
|
| Hospital Charge Code |
2226
|
| 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
|
|
|
047L04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L04Z
|
| Hospital Charge Code |
2227
|
| 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
|
|
|
047L05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L05Z
|
| Hospital Charge Code |
2228
|
| 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
|
|
