|
047F341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F341
|
| Hospital Charge Code |
2171
|
| 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
|
|
|
047F34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F34Z
|
| Hospital Charge Code |
2172
|
| 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
|
|
|
047F35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F35Z
|
| Hospital Charge Code |
2173
|
| 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
|
|
|
047F36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F36Z
|
| Hospital Charge Code |
2174
|
| 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
|
|
|
047F37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F37Z
|
| Hospital Charge Code |
2175
|
| 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
|
|
|
047F3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F3D1
|
| Hospital Charge Code |
4344
|
| 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
|
|
|
047F3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F3D6
|
| Hospital Charge Code |
4345
|
| 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
|
|
|
047F3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F3DZ
|
| Hospital Charge Code |
4346
|
| 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
|
|
|
047F3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F3EZ
|
| Hospital Charge Code |
4347
|
| 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
|
|
|
047F3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F3FZ
|
| Hospital Charge Code |
4348
|
| 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
|
|
|
047F3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F3GZ
|
| Hospital Charge Code |
4349
|
| 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
|
|
|
047F441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F441
|
| Hospital Charge Code |
2176
|
| 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
|
|
|
047F44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F44Z
|
| Hospital Charge Code |
2177
|
| 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
|
|
|
047F45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F45Z
|
| Hospital Charge Code |
2178
|
| 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
|
|
|
047F46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F46Z
|
| Hospital Charge Code |
2179
|
| 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
|
|
|
047F47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047F47Z
|
| Hospital Charge Code |
2180
|
| 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
|
|
|
047F4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F4D1
|
| Hospital Charge Code |
4350
|
| 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
|
|
|
047F4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F4D6
|
| Hospital Charge Code |
4351
|
| 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
|
|
|
047F4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F4DZ
|
| Hospital Charge Code |
4352
|
| 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
|
|
|
047F4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F4EZ
|
| Hospital Charge Code |
4353
|
| 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
|
|
|
047F4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F4FZ
|
| Hospital Charge Code |
4354
|
| 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
|
|
|
047F4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047F4GZ
|
| Hospital Charge Code |
4355
|
| 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
|
|
|
047H041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H041
|
| Hospital Charge Code |
2181
|
| 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
|
|
|
047H04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H04Z
|
| Hospital Charge Code |
2182
|
| 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
|
|
|
047H05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H05Z
|
| Hospital Charge Code |
2183
|
| 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
|
|
