|
047L06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L06Z
|
| Hospital Charge Code |
2229
|
| 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
|
|
|
047L07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L07Z
|
| Hospital Charge Code |
2230
|
| 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
|
|
|
047L341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L341
|
| Hospital Charge Code |
2231
|
| 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
|
|
|
047L34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L34Z
|
| Hospital Charge Code |
2232
|
| 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
|
|
|
047L35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L35Z
|
| Hospital Charge Code |
2233
|
| 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
|
|
|
047L36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L36Z
|
| Hospital Charge Code |
2234
|
| 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
|
|
|
047L37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L37Z
|
| Hospital Charge Code |
2235
|
| 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
|
|
|
047L441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L441
|
| Hospital Charge Code |
2236
|
| 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
|
|
|
047L44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L44Z
|
| Hospital Charge Code |
2237
|
| 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
|
|
|
047L45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L45Z
|
| Hospital Charge Code |
2238
|
| 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
|
|
|
047L46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L46Z
|
| Hospital Charge Code |
2239
|
| 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
|
|
|
047L47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L47Z
|
| Hospital Charge Code |
2240
|
| 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
|
|
|
047L4D1
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047L4D1
|
| Hospital Charge Code |
2241
|
| 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
|
|
|
047M041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M041
|
| Hospital Charge Code |
2242
|
| 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
|
|
|
047M04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M04Z
|
| Hospital Charge Code |
2243
|
| 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
|
|
|
047M05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M05Z
|
| Hospital Charge Code |
2244
|
| 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
|
|
|
047M06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M06Z
|
| Hospital Charge Code |
2245
|
| 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
|
|
|
047M07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M07Z
|
| Hospital Charge Code |
2246
|
| 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
|
|
|
047M341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M341
|
| Hospital Charge Code |
2247
|
| 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
|
|
|
047M34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M34Z
|
| Hospital Charge Code |
2248
|
| 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
|
|
|
047M35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M35Z
|
| Hospital Charge Code |
2249
|
| 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
|
|
|
047M36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M36Z
|
| Hospital Charge Code |
2250
|
| 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
|
|
|
047M37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M37Z
|
| Hospital Charge Code |
2251
|
| 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
|
|
|
047M441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M441
|
| Hospital Charge Code |
2252
|
| 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
|
|
|
047M44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047M44Z
|
| Hospital Charge Code |
2253
|
| 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
|
|
