|
047L4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047L4DZ
|
| Hospital Charge Code |
4423
|
| 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
|
|
|
047L4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047L4EZ
|
| Hospital Charge Code |
4424
|
| 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
|
|
|
047L4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047L4FZ
|
| Hospital Charge Code |
4425
|
| 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
|
|
|
047L4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047L4GZ
|
| Hospital Charge Code |
4426
|
| 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
|
|
|
047M041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M041
|
| Hospital Charge Code |
2242
|
| 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
|
|
|
047M04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M04Z
|
| Hospital Charge Code |
2243
|
| 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
|
|
|
047M05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M05Z
|
| Hospital Charge Code |
2244
|
| 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
|
|
|
047M06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M06Z
|
| Hospital Charge Code |
2245
|
| 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
|
|
|
047M07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M07Z
|
| Hospital Charge Code |
2246
|
| 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
|
|
|
047M0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M0D1
|
| Hospital Charge Code |
4427
|
| 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
|
|
|
047M0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M0D6
|
| Hospital Charge Code |
4428
|
| 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
|
|
|
047M0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M0DZ
|
| Hospital Charge Code |
4429
|
| 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
|
|
|
047M0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M0EZ
|
| Hospital Charge Code |
4430
|
| 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
|
|
|
047M0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M0FZ
|
| Hospital Charge Code |
4431
|
| 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
|
|
|
047M0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M0GZ
|
| Hospital Charge Code |
4432
|
| 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
|
|
|
047M341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M341
|
| Hospital Charge Code |
2247
|
| 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
|
|
|
047M34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M34Z
|
| Hospital Charge Code |
2248
|
| 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
|
|
|
047M35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M35Z
|
| Hospital Charge Code |
2249
|
| 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
|
|
|
047M36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M36Z
|
| Hospital Charge Code |
2250
|
| 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
|
|
|
047M37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M37Z
|
| Hospital Charge Code |
2251
|
| 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
|
|
|
047M3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M3D1
|
| Hospital Charge Code |
4433
|
| 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
|
|
|
047M3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M3D6
|
| Hospital Charge Code |
4434
|
| 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
|
|
|
047M3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M3DZ
|
| Hospital Charge Code |
4435
|
| 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
|
|
|
047M3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M3EZ
|
| Hospital Charge Code |
4436
|
| 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
|
|
|
047M3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M3FZ
|
| Hospital Charge Code |
4437
|
| 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
|
|
