|
047S45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047S45Z
|
| Hospital Charge Code |
2329
|
| 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
|
|
|
047S46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047S46Z
|
| Hospital Charge Code |
2330
|
| 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
|
|
|
047S47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047S47Z
|
| Hospital Charge Code |
2331
|
| 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
|
|
|
047T041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T041
|
| Hospital Charge Code |
2332
|
| 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
|
|
|
047T04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T04Z
|
| Hospital Charge Code |
2333
|
| 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
|
|
|
047T05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T05Z
|
| Hospital Charge Code |
2334
|
| 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
|
|
|
047T06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T06Z
|
| Hospital Charge Code |
2335
|
| 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
|
|
|
047T07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T07Z
|
| Hospital Charge Code |
2336
|
| 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
|
|
|
047T341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T341
|
| Hospital Charge Code |
2337
|
| 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
|
|
|
047T34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T34Z
|
| Hospital Charge Code |
2338
|
| 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
|
|
|
047T35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T35Z
|
| Hospital Charge Code |
2339
|
| 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
|
|
|
047T36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T36Z
|
| Hospital Charge Code |
2340
|
| 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
|
|
|
047T37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T37Z
|
| Hospital Charge Code |
2341
|
| 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
|
|
|
047T441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T441
|
| Hospital Charge Code |
2342
|
| 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
|
|
|
047T44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T44Z
|
| Hospital Charge Code |
2343
|
| 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
|
|
|
047T45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T45Z
|
| Hospital Charge Code |
2344
|
| 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
|
|
|
047T46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T46Z
|
| Hospital Charge Code |
2345
|
| 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
|
|
|
047T47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047T47Z
|
| Hospital Charge Code |
2346
|
| 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
|
|
|
047U041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U041
|
| Hospital Charge Code |
2347
|
| 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
|
|
|
047U04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U04Z
|
| Hospital Charge Code |
2348
|
| 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
|
|
|
047U05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U05Z
|
| Hospital Charge Code |
2349
|
| 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
|
|
|
047U06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U06Z
|
| Hospital Charge Code |
2350
|
| 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
|
|
|
047U07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U07Z
|
| Hospital Charge Code |
2351
|
| 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
|
|
|
047U341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U341
|
| Hospital Charge Code |
2352
|
| 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
|
|
|
047U34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U34Z
|
| Hospital Charge Code |
2353
|
| 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
|
|
