|
047H06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H06Z
|
| Hospital Charge Code |
2184
|
| 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
|
|
|
047H07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H07Z
|
| Hospital Charge Code |
2185
|
| 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
|
|
|
047H0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H0D1
|
| Hospital Charge Code |
4356
|
| 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
|
|
|
047H0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H0D6
|
| Hospital Charge Code |
4357
|
| 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
|
|
|
047H0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H0DZ
|
| Hospital Charge Code |
4358
|
| 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
|
|
|
047H0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H0EZ
|
| Hospital Charge Code |
4359
|
| 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
|
|
|
047H0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H0FZ
|
| Hospital Charge Code |
4360
|
| 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
|
|
|
047H0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H0GZ
|
| Hospital Charge Code |
4361
|
| 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
|
|
|
047H341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H341
|
| Hospital Charge Code |
2186
|
| 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
|
|
|
047H34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H34Z
|
| Hospital Charge Code |
2187
|
| 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
|
|
|
047H35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H35Z
|
| Hospital Charge Code |
2188
|
| 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
|
|
|
047H36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H36Z
|
| Hospital Charge Code |
2189
|
| 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
|
|
|
047H37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H37Z
|
| Hospital Charge Code |
2190
|
| 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
|
|
|
047H3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H3D1
|
| Hospital Charge Code |
4362
|
| 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
|
|
|
047H3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H3D6
|
| Hospital Charge Code |
4363
|
| 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
|
|
|
047H3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H3DZ
|
| Hospital Charge Code |
4364
|
| 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
|
|
|
047H3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H3EZ
|
| Hospital Charge Code |
4365
|
| 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
|
|
|
047H3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H3FZ
|
| Hospital Charge Code |
4366
|
| 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
|
|
|
047H3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H3GZ
|
| Hospital Charge Code |
4367
|
| 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
|
|
|
047H441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H441
|
| Hospital Charge Code |
2191
|
| 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
|
|
|
047H44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H44Z
|
| Hospital Charge Code |
2192
|
| 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
|
|
|
047H45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H45Z
|
| Hospital Charge Code |
2193
|
| 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
|
|
|
047H46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H46Z
|
| Hospital Charge Code |
2194
|
| 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
|
|
|
047H47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047H47Z
|
| Hospital Charge Code |
2195
|
| 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
|
|
|
047H4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H4D1
|
| Hospital Charge Code |
4368
|
| 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
|
|
