|
047P35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P35Z
|
| Hospital Charge Code |
2279
|
| 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
|
|
|
047P36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P36Z
|
| Hospital Charge Code |
2280
|
| 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
|
|
|
047P37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P37Z
|
| Hospital Charge Code |
2281
|
| 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
|
|
|
047P441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P441
|
| Hospital Charge Code |
2282
|
| 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
|
|
|
047P44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P44Z
|
| Hospital Charge Code |
2283
|
| 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
|
|
|
047P45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P45Z
|
| Hospital Charge Code |
2284
|
| 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
|
|
|
047P46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P46Z
|
| Hospital Charge Code |
2285
|
| 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
|
|
|
047P47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047P47Z
|
| Hospital Charge Code |
2286
|
| 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
|
|
|
047Q041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q041
|
| Hospital Charge Code |
2287
|
| 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
|
|
|
047Q04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q04Z
|
| Hospital Charge Code |
2288
|
| 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
|
|
|
047Q05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q05Z
|
| Hospital Charge Code |
2289
|
| 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
|
|
|
047Q06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q06Z
|
| Hospital Charge Code |
2290
|
| 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
|
|
|
047Q07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q07Z
|
| Hospital Charge Code |
2291
|
| 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
|
|
|
047Q341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q341
|
| Hospital Charge Code |
2292
|
| 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
|
|
|
047Q34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q34Z
|
| Hospital Charge Code |
2293
|
| 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
|
|
|
047Q35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q35Z
|
| Hospital Charge Code |
2294
|
| 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
|
|
|
047Q36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q36Z
|
| Hospital Charge Code |
2295
|
| 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
|
|
|
047Q37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q37Z
|
| Hospital Charge Code |
2296
|
| 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
|
|
|
047Q441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q441
|
| Hospital Charge Code |
2297
|
| 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
|
|
|
047Q44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q44Z
|
| Hospital Charge Code |
2298
|
| 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
|
|
|
047Q45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q45Z
|
| Hospital Charge Code |
2299
|
| 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
|
|
|
047Q46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q46Z
|
| Hospital Charge Code |
2300
|
| 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
|
|
|
047Q47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047Q47Z
|
| Hospital Charge Code |
2301
|
| 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
|
|
|
047R041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047R041
|
| Hospital Charge Code |
2302
|
| 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
|
|
|
047R04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047R04Z
|
| Hospital Charge Code |
2303
|
| 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
|
|
