|
047D4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D4D1
|
| Hospital Charge Code |
4313
|
| 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
|
|
|
047D4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D4D6
|
| Hospital Charge Code |
4314
|
| 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
|
|
|
047D4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D4DZ
|
| Hospital Charge Code |
4315
|
| 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
|
|
|
047D4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D4EZ
|
| Hospital Charge Code |
4316
|
| 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
|
|
|
047D4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D4FZ
|
| Hospital Charge Code |
4317
|
| 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
|
|
|
047D4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047D4GZ
|
| Hospital Charge Code |
4318
|
| 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
|
|
|
047E041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E041
|
| Hospital Charge Code |
4319
|
| 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
|
|
|
047E04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E04Z
|
| Hospital Charge Code |
2152
|
| 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
|
|
|
047E05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E05Z
|
| Hospital Charge Code |
2153
|
| 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
|
|
|
047E06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E06Z
|
| Hospital Charge Code |
2154
|
| 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
|
|
|
047E07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E07Z
|
| Hospital Charge Code |
2155
|
| 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
|
|
|
047E0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E0D1
|
| Hospital Charge Code |
4320
|
| 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
|
|
|
047E0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E0D6
|
| Hospital Charge Code |
4321
|
| 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
|
|
|
047E0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E0DZ
|
| Hospital Charge Code |
4322
|
| 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
|
|
|
047E0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E0EZ
|
| Hospital Charge Code |
4323
|
| 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
|
|
|
047E0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E0FZ
|
| Hospital Charge Code |
4324
|
| 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
|
|
|
047E0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E0GZ
|
| Hospital Charge Code |
4325
|
| 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
|
|
|
047E341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E341
|
| Hospital Charge Code |
2156
|
| 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
|
|
|
047E34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E34Z
|
| Hospital Charge Code |
2157
|
| 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
|
|
|
047E35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E35Z
|
| Hospital Charge Code |
2158
|
| 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
|
|
|
047E36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E36Z
|
| Hospital Charge Code |
2159
|
| 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
|
|
|
047E37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047E37Z
|
| Hospital Charge Code |
2160
|
| 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
|
|
|
047E3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E3D1
|
| Hospital Charge Code |
4326
|
| 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
|
|
|
047E3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E3D6
|
| Hospital Charge Code |
4327
|
| 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
|
|
|
047E3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047E3DZ
|
| Hospital Charge Code |
4328
|
| 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
|
|
