|
047U35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U35Z
|
| Hospital Charge Code |
2354
|
| 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
|
|
|
047U36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U36Z
|
| Hospital Charge Code |
2355
|
| 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
|
|
|
047U37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U37Z
|
| Hospital Charge Code |
2356
|
| 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
|
|
|
047U441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U441
|
| Hospital Charge Code |
2357
|
| 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
|
|
|
047U44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U44Z
|
| Hospital Charge Code |
2358
|
| 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
|
|
|
047U45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U45Z
|
| Hospital Charge Code |
2359
|
| 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
|
|
|
047U46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U46Z
|
| Hospital Charge Code |
2360
|
| 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
|
|
|
047U47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047U47Z
|
| Hospital Charge Code |
2361
|
| 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
|
|
|
047V041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V041
|
| Hospital Charge Code |
2362
|
| 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
|
|
|
047V04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V04Z
|
| Hospital Charge Code |
2363
|
| 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
|
|
|
047V05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V05Z
|
| Hospital Charge Code |
2364
|
| 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
|
|
|
047V06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V06Z
|
| Hospital Charge Code |
2365
|
| 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
|
|
|
047V07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V07Z
|
| Hospital Charge Code |
2366
|
| 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
|
|
|
047V341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V341
|
| Hospital Charge Code |
2367
|
| 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
|
|
|
047V34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V34Z
|
| Hospital Charge Code |
2368
|
| 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
|
|
|
047V35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V35Z
|
| Hospital Charge Code |
2369
|
| 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
|
|
|
047V36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V36Z
|
| Hospital Charge Code |
2370
|
| 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
|
|
|
047V37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V37Z
|
| Hospital Charge Code |
2371
|
| 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
|
|
|
047V441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V441
|
| Hospital Charge Code |
2372
|
| 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
|
|
|
047V44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V44Z
|
| Hospital Charge Code |
2373
|
| 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
|
|
|
047V45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V45Z
|
| Hospital Charge Code |
2374
|
| 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
|
|
|
047V46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V46Z
|
| Hospital Charge Code |
2375
|
| 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
|
|
|
047V47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047V47Z
|
| Hospital Charge Code |
2376
|
| 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
|
|
|
047W041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W041
|
| Hospital Charge Code |
2377
|
| 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
|
|
|
047W04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W04Z
|
| Hospital Charge Code |
2378
|
| 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
|
|
