|
047R36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R36Z
|
| Hospital Charge Code |
2310
|
| 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
|
|
|
047R37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R37Z
|
| Hospital Charge Code |
2311
|
| 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
|
|
|
047R3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R3D1
|
| Hospital Charge Code |
4505
|
| 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
|
|
|
047R3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R3D6
|
| Hospital Charge Code |
4506
|
| 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
|
|
|
047R3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R3DZ
|
| Hospital Charge Code |
4507
|
| 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
|
|
|
047R3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R3EZ
|
| Hospital Charge Code |
4508
|
| 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
|
|
|
047R3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R3FZ
|
| Hospital Charge Code |
4509
|
| 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
|
|
|
047R3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R3GZ
|
| Hospital Charge Code |
4510
|
| 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
|
|
|
047R441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R441
|
| Hospital Charge Code |
2312
|
| 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
|
|
|
047R44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R44Z
|
| Hospital Charge Code |
2313
|
| 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
|
|
|
047R45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R45Z
|
| Hospital Charge Code |
2314
|
| 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
|
|
|
047R46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R46Z
|
| Hospital Charge Code |
2315
|
| 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
|
|
|
047R47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047R47Z
|
| Hospital Charge Code |
2316
|
| 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
|
|
|
047R4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R4D1
|
| Hospital Charge Code |
4511
|
| 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
|
|
|
047R4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R4D6
|
| Hospital Charge Code |
4512
|
| 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
|
|
|
047R4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R4DZ
|
| Hospital Charge Code |
4513
|
| 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
|
|
|
047R4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R4EZ
|
| Hospital Charge Code |
4514
|
| 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
|
|
|
047R4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R4FZ
|
| Hospital Charge Code |
4515
|
| 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
|
|
|
047R4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047R4GZ
|
| Hospital Charge Code |
4516
|
| 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
|
|
|
047S041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S041
|
| Hospital Charge Code |
2317
|
| 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
|
|
|
047S04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S04Z
|
| Hospital Charge Code |
2318
|
| 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
|
|
|
047S05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S05Z
|
| Hospital Charge Code |
2319
|
| 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
|
|
|
047S06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S06Z
|
| Hospital Charge Code |
2320
|
| 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
|
|
|
047S07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S07Z
|
| Hospital Charge Code |
2321
|
| 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
|
|
|
047S0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S0D1
|
| Hospital Charge Code |
4517
|
| 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
|
|
