|
047P4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047P4EZ
|
| Hospital Charge Code |
4478
|
| 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
|
|
|
047P4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047P4FZ
|
| Hospital Charge Code |
4479
|
| 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
|
|
|
047P4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047P4GZ
|
| Hospital Charge Code |
4480
|
| 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
|
|
|
047Q041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q041
|
| Hospital Charge Code |
2287
|
| 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
|
|
|
047Q04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q04Z
|
| Hospital Charge Code |
2288
|
| 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
|
|
|
047Q05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q05Z
|
| Hospital Charge Code |
2289
|
| 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
|
|
|
047Q06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q06Z
|
| Hospital Charge Code |
2290
|
| 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
|
|
|
047Q07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q07Z
|
| Hospital Charge Code |
2291
|
| 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
|
|
|
047Q0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q0D1
|
| Hospital Charge Code |
4481
|
| 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
|
|
|
047Q0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q0D6
|
| Hospital Charge Code |
4482
|
| 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
|
|
|
047Q0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q0DZ
|
| Hospital Charge Code |
4483
|
| 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
|
|
|
047Q0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q0EZ
|
| Hospital Charge Code |
4484
|
| 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
|
|
|
047Q0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q0FZ
|
| Hospital Charge Code |
4485
|
| 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
|
|
|
047Q0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q0GZ
|
| Hospital Charge Code |
4486
|
| 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
|
|
|
047Q341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q341
|
| Hospital Charge Code |
2292
|
| 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
|
|
|
047Q34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q34Z
|
| Hospital Charge Code |
2293
|
| 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
|
|
|
047Q35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q35Z
|
| Hospital Charge Code |
2294
|
| 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
|
|
|
047Q36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q36Z
|
| Hospital Charge Code |
2295
|
| 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
|
|
|
047Q37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q37Z
|
| Hospital Charge Code |
2296
|
| 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
|
|
|
047Q3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q3D1
|
| Hospital Charge Code |
4487
|
| 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
|
|
|
047Q3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q3D6
|
| Hospital Charge Code |
4488
|
| 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
|
|
|
047Q3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q3DZ
|
| Hospital Charge Code |
4489
|
| 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
|
|
|
047Q3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q3EZ
|
| Hospital Charge Code |
4490
|
| 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
|
|
|
047Q3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q3FZ
|
| Hospital Charge Code |
4491
|
| 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
|
|
|
047Q3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q3GZ
|
| Hospital Charge Code |
4492
|
| 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
|
|
