|
047A47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047A47Z
|
| Hospital Charge Code |
2106
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047A4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047A4D1
|
| Hospital Charge Code |
4259
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047A4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047A4D6
|
| Hospital Charge Code |
4260
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047A4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047A4DZ
|
| Hospital Charge Code |
4261
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047A4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047A4EZ
|
| Hospital Charge Code |
4262
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047A4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047A4FZ
|
| Hospital Charge Code |
4263
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047A4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047A4GZ
|
| Hospital Charge Code |
4264
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B041
|
| Hospital Charge Code |
2107
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B04Z
|
| Hospital Charge Code |
2108
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B05Z
|
| Hospital Charge Code |
2109
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B06Z
|
| Hospital Charge Code |
2110
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B07Z
|
| Hospital Charge Code |
2111
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B0D1
|
| Hospital Charge Code |
4265
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B0D6
|
| Hospital Charge Code |
4266
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B0DZ
|
| Hospital Charge Code |
4267
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B0EZ
|
| Hospital Charge Code |
4268
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B0FZ
|
| Hospital Charge Code |
4269
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B0GZ
|
| Hospital Charge Code |
4270
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B341
|
| Hospital Charge Code |
2112
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B34Z
|
| Hospital Charge Code |
2113
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B35Z
|
| Hospital Charge Code |
2114
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B36Z
|
| Hospital Charge Code |
2115
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047B37Z
|
| Hospital Charge Code |
2116
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B3D1
|
| Hospital Charge Code |
4271
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047B3D6
|
| Hospital Charge Code |
4272
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
