|
047Y45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y45Z
|
| Hospital Charge Code |
2404
|
| 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
|
|
|
047Y46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y46Z
|
| Hospital Charge Code |
2405
|
| 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
|
|
|
047Y47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Y47Z
|
| Hospital Charge Code |
2406
|
| 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
|
|
|
04C03ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C03ZZ
|
| Hospital Charge Code |
2407
|
| 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
|
|
|
04C13ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C13ZZ
|
| Hospital Charge Code |
2408
|
| 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
|
|
|
04C23ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C23ZZ
|
| Hospital Charge Code |
2409
|
| 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
|
|
|
04C33ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C33ZZ
|
| Hospital Charge Code |
2410
|
| 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
|
|
|
04C43ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C43ZZ
|
| Hospital Charge Code |
2411
|
| 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
|
|
|
04C53ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C53ZZ
|
| Hospital Charge Code |
2412
|
| 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
|
|
|
04C63ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C63ZZ
|
| Hospital Charge Code |
2413
|
| 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
|
|
|
04C73ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C73ZZ
|
| Hospital Charge Code |
2414
|
| 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
|
|
|
04C83ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C83ZZ
|
| Hospital Charge Code |
2415
|
| 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
|
|
|
04C93ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04C93ZZ
|
| Hospital Charge Code |
2416
|
| 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
|
|
|
04CA3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CA3ZZ
|
| Hospital Charge Code |
2417
|
| 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
|
|
|
04CB3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CB3ZZ
|
| Hospital Charge Code |
2418
|
| 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
|
|
|
04CC3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CC3ZZ
|
| Hospital Charge Code |
2419
|
| 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
|
|
|
04CD3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CD3ZZ
|
| Hospital Charge Code |
2420
|
| 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
|
|
|
04CE3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CE3ZZ
|
| Hospital Charge Code |
2421
|
| 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
|
|
|
04CF3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CF3ZZ
|
| Hospital Charge Code |
2422
|
| 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
|
|
|
04CH3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CH3ZZ
|
| Hospital Charge Code |
2423
|
| 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
|
|
|
04CJ3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CJ3ZZ
|
| Hospital Charge Code |
2424
|
| 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
|
|
|
04CK3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CK3ZZ
|
| Hospital Charge Code |
2425
|
| 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
|
|
|
04CL3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CL3ZZ
|
| Hospital Charge Code |
2426
|
| 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
|
|
|
04CM3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CM3ZZ
|
| Hospital Charge Code |
2427
|
| 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
|
|
|
04CN3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CN3ZZ
|
| Hospital Charge Code |
2428
|
| 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
|
|
