|
047S4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S4FZ
|
| Hospital Charge Code |
4533
|
| 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
|
|
|
047S4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047S4GZ
|
| Hospital Charge Code |
4534
|
| 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
|
|
|
047T041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T041
|
| Hospital Charge Code |
2332
|
| 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
|
|
|
047T04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T04Z
|
| Hospital Charge Code |
2333
|
| 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
|
|
|
047T05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T05Z
|
| Hospital Charge Code |
2334
|
| 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
|
|
|
047T06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T06Z
|
| Hospital Charge Code |
2335
|
| 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
|
|
|
047T07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T07Z
|
| Hospital Charge Code |
2336
|
| 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
|
|
|
047T0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T0D1
|
| Hospital Charge Code |
4535
|
| 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
|
|
|
047T0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T0D6
|
| Hospital Charge Code |
4536
|
| 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
|
|
|
047T0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T0DZ
|
| Hospital Charge Code |
4537
|
| 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
|
|
|
047T0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T0EZ
|
| Hospital Charge Code |
4538
|
| 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
|
|
|
047T0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T0FZ
|
| Hospital Charge Code |
4539
|
| 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
|
|
|
047T0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T0GZ
|
| Hospital Charge Code |
4540
|
| 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
|
|
|
047T341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T341
|
| Hospital Charge Code |
2337
|
| 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
|
|
|
047T34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T34Z
|
| Hospital Charge Code |
2338
|
| 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
|
|
|
047T35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T35Z
|
| Hospital Charge Code |
2339
|
| 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
|
|
|
047T36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T36Z
|
| Hospital Charge Code |
2340
|
| 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
|
|
|
047T37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T37Z
|
| Hospital Charge Code |
2341
|
| 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
|
|
|
047T3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T3D1
|
| Hospital Charge Code |
4541
|
| 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
|
|
|
047T3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T3D6
|
| Hospital Charge Code |
4542
|
| 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
|
|
|
047T3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T3DZ
|
| Hospital Charge Code |
4543
|
| 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
|
|
|
047T3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T3EZ
|
| Hospital Charge Code |
4544
|
| 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
|
|
|
047T3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T3FZ
|
| Hospital Charge Code |
4545
|
| 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
|
|
|
047T3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047T3GZ
|
| Hospital Charge Code |
4546
|
| 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
|
|
|
047T441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047T441
|
| Hospital Charge Code |
2342
|
| 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
|
|
