|
047Q441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q441
|
| Hospital Charge Code |
2297
|
| 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
|
|
|
047Q44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q44Z
|
| Hospital Charge Code |
2298
|
| 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
|
|
|
047Q45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q45Z
|
| Hospital Charge Code |
2299
|
| 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
|
|
|
047Q46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q46Z
|
| Hospital Charge Code |
2300
|
| 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
|
|
|
047Q47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Q47Z
|
| Hospital Charge Code |
2301
|
| 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
|
|
|
047Q4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q4D1
|
| Hospital Charge Code |
4493
|
| 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
|
|
|
047Q4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q4D6
|
| Hospital Charge Code |
4494
|
| 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
|
|
|
047Q4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q4DZ
|
| Hospital Charge Code |
4495
|
| 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
|
|
|
047Q4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q4EZ
|
| Hospital Charge Code |
4496
|
| 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
|
|
|
047Q4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q4FZ
|
| Hospital Charge Code |
4497
|
| 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
|
|
|
047Q4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Q4GZ
|
| Hospital Charge Code |
4498
|
| 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
|
|
|
047R041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R041
|
| Hospital Charge Code |
2302
|
| 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
|
|
|
047R04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R04Z
|
| Hospital Charge Code |
2303
|
| 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
|
|
|
047R05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R05Z
|
| Hospital Charge Code |
2304
|
| 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
|
|
|
047R06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R06Z
|
| Hospital Charge Code |
2305
|
| 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
|
|
|
047R07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R07Z
|
| Hospital Charge Code |
2306
|
| 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
|
|
|
047R0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R0D1
|
| Hospital Charge Code |
4499
|
| 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
|
|
|
047R0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R0D6
|
| Hospital Charge Code |
4500
|
| 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
|
|
|
047R0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R0DZ
|
| Hospital Charge Code |
4501
|
| 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
|
|
|
047R0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R0EZ
|
| Hospital Charge Code |
4502
|
| 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
|
|
|
047R0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R0FZ
|
| Hospital Charge Code |
4503
|
| 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
|
|
|
047R0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R0GZ
|
| Hospital Charge Code |
4504
|
| 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
|
|
|
047R341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R341
|
| Hospital Charge Code |
2307
|
| 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
|
|
|
047R34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R34Z
|
| Hospital Charge Code |
2308
|
| 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
|
|
|
047R35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R35Z
|
| Hospital Charge Code |
2309
|
| 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
|
|
