|
047S0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S0D6
|
| Hospital Charge Code |
4518
|
| 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
|
|
|
047S0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S0DZ
|
| Hospital Charge Code |
4519
|
| 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
|
|
|
047S0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S0EZ
|
| Hospital Charge Code |
4520
|
| 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
|
|
|
047S0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S0FZ
|
| Hospital Charge Code |
4521
|
| 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
|
|
|
047S0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S0GZ
|
| Hospital Charge Code |
4522
|
| 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
|
|
|
047S341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S341
|
| Hospital Charge Code |
2322
|
| 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
|
|
|
047S34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S34Z
|
| Hospital Charge Code |
2323
|
| 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
|
|
|
047S35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S35Z
|
| Hospital Charge Code |
2324
|
| 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
|
|
|
047S36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S36Z
|
| Hospital Charge Code |
2325
|
| 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
|
|
|
047S37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S37Z
|
| Hospital Charge Code |
2326
|
| 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
|
|
|
047S3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S3D1
|
| Hospital Charge Code |
4523
|
| 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
|
|
|
047S3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S3D6
|
| Hospital Charge Code |
4524
|
| 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
|
|
|
047S3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S3DZ
|
| Hospital Charge Code |
4525
|
| 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
|
|
|
047S3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S3EZ
|
| Hospital Charge Code |
4526
|
| 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
|
|
|
047S3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S3FZ
|
| Hospital Charge Code |
4527
|
| 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
|
|
|
047S3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S3GZ
|
| Hospital Charge Code |
4528
|
| 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
|
|
|
047S441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S441
|
| Hospital Charge Code |
2327
|
| 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
|
|
|
047S44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S44Z
|
| Hospital Charge Code |
2328
|
| 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
|
|
|
047S45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S45Z
|
| Hospital Charge Code |
2329
|
| 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
|
|
|
047S46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S46Z
|
| Hospital Charge Code |
2330
|
| 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
|
|
|
047S47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047S47Z
|
| Hospital Charge Code |
2331
|
| 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
|
|
|
047S4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S4D1
|
| Hospital Charge Code |
4529
|
| 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
|
|
|
047S4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S4D6
|
| Hospital Charge Code |
4530
|
| 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
|
|
|
047S4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S4DZ
|
| Hospital Charge Code |
4531
|
| 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
|
|
|
047S4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S4EZ
|
| Hospital Charge Code |
4532
|
| 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
|
|
