|
047W05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W05Z
|
| Hospital Charge Code |
2379
|
| 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
|
|
|
047W06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W06Z
|
| Hospital Charge Code |
2380
|
| 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
|
|
|
047W07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W07Z
|
| Hospital Charge Code |
2381
|
| 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
|
|
|
047W341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W341
|
| Hospital Charge Code |
2382
|
| 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
|
|
|
047W34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W34Z
|
| Hospital Charge Code |
2383
|
| 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
|
|
|
047W35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W35Z
|
| Hospital Charge Code |
2384
|
| 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
|
|
|
047W36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W36Z
|
| Hospital Charge Code |
2385
|
| 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
|
|
|
047W37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W37Z
|
| Hospital Charge Code |
2386
|
| 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
|
|
|
047W441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W441
|
| Hospital Charge Code |
2387
|
| 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
|
|
|
047W44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W44Z
|
| Hospital Charge Code |
2388
|
| 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
|
|
|
047W45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W45Z
|
| Hospital Charge Code |
2389
|
| 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
|
|
|
047W46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W46Z
|
| Hospital Charge Code |
2390
|
| 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
|
|
|
047W47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047W47Z
|
| Hospital Charge Code |
2391
|
| 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
|
|
|
047Y041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y041
|
| Hospital Charge Code |
2392
|
| 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
|
|
|
047Y04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y04Z
|
| Hospital Charge Code |
2393
|
| 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
|
|
|
047Y05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y05Z
|
| Hospital Charge Code |
2394
|
| 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
|
|
|
047Y06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y06Z
|
| Hospital Charge Code |
2395
|
| 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
|
|
|
047Y07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y07Z
|
| Hospital Charge Code |
2396
|
| 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
|
|
|
047Y341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y341
|
| Hospital Charge Code |
2397
|
| 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
|
|
|
047Y34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y34Z
|
| Hospital Charge Code |
2398
|
| 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
|
|
|
047Y35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y35Z
|
| Hospital Charge Code |
2399
|
| 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
|
|
|
047Y36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y36Z
|
| Hospital Charge Code |
2400
|
| 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
|
|
|
047Y37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y37Z
|
| Hospital Charge Code |
2401
|
| 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
|
|
|
047Y441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y441
|
| Hospital Charge Code |
2402
|
| 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
|
|
|
047Y44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y44Z
|
| Hospital Charge Code |
2403
|
| 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
|
|
