|
047D05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D05Z
|
| Hospital Charge Code |
2139
|
| 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
|
|
|
047D06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D06Z
|
| Hospital Charge Code |
2140
|
| 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
|
|
|
047D07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D07Z
|
| Hospital Charge Code |
2141
|
| 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
|
|
|
047D0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D0D1
|
| Hospital Charge Code |
4301
|
| 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
|
|
|
047D0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D0D6
|
| Hospital Charge Code |
4302
|
| 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
|
|
|
047D0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D0DZ
|
| Hospital Charge Code |
4303
|
| 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
|
|
|
047D0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D0EZ
|
| Hospital Charge Code |
4304
|
| 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
|
|
|
047D0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D0FZ
|
| Hospital Charge Code |
4305
|
| 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
|
|
|
047D0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D0GZ
|
| Hospital Charge Code |
4306
|
| 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
|
|
|
047D341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D341
|
| Hospital Charge Code |
2142
|
| 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
|
|
|
047D34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D34Z
|
| Hospital Charge Code |
2143
|
| 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
|
|
|
047D35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D35Z
|
| Hospital Charge Code |
2144
|
| 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
|
|
|
047D36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D36Z
|
| Hospital Charge Code |
2145
|
| 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
|
|
|
047D37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D37Z
|
| Hospital Charge Code |
2146
|
| 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
|
|
|
047D3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D3D1
|
| Hospital Charge Code |
4307
|
| 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
|
|
|
047D3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D3D6
|
| Hospital Charge Code |
4308
|
| 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
|
|
|
047D3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D3DZ
|
| Hospital Charge Code |
4309
|
| 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
|
|
|
047D3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D3EZ
|
| Hospital Charge Code |
4310
|
| 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
|
|
|
047D3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D3FZ
|
| Hospital Charge Code |
4311
|
| 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
|
|
|
047D3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D3GZ
|
| Hospital Charge Code |
4312
|
| 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
|
|
|
047D441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D441
|
| Hospital Charge Code |
2147
|
| 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
|
|
|
047D44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D44Z
|
| Hospital Charge Code |
2148
|
| 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
|
|
|
047D45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D45Z
|
| Hospital Charge Code |
2149
|
| 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
|
|
|
047D46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D46Z
|
| Hospital Charge Code |
2150
|
| 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
|
|
|
047D47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047D47Z
|
| Hospital Charge Code |
2151
|
| 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
|
|
