|
047U37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047U37Z
|
| Hospital Charge Code |
2356
|
| 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
|
|
|
047U3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U3D1
|
| Hospital Charge Code |
4559
|
| 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
|
|
|
047U3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U3D6
|
| Hospital Charge Code |
4560
|
| 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
|
|
|
047U3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U3DZ
|
| Hospital Charge Code |
4561
|
| 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
|
|
|
047U3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U3EZ
|
| Hospital Charge Code |
4562
|
| 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
|
|
|
047U3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U3FZ
|
| Hospital Charge Code |
4563
|
| 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
|
|
|
047U3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U3GZ
|
| Hospital Charge Code |
4564
|
| 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
|
|
|
047U441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047U441
|
| Hospital Charge Code |
2357
|
| 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
|
|
|
047U44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047U44Z
|
| Hospital Charge Code |
2358
|
| 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
|
|
|
047U45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047U45Z
|
| Hospital Charge Code |
2359
|
| 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
|
|
|
047U46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047U46Z
|
| Hospital Charge Code |
2360
|
| 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
|
|
|
047U47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047U47Z
|
| Hospital Charge Code |
2361
|
| 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
|
|
|
047U4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U4D1
|
| Hospital Charge Code |
4565
|
| 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
|
|
|
047U4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U4D6
|
| Hospital Charge Code |
4566
|
| 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
|
|
|
047U4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U4DZ
|
| Hospital Charge Code |
4567
|
| 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
|
|
|
047U4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U4EZ
|
| Hospital Charge Code |
4568
|
| 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
|
|
|
047U4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U4FZ
|
| Hospital Charge Code |
4569
|
| 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
|
|
|
047U4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047U4GZ
|
| Hospital Charge Code |
4570
|
| 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
|
|
|
047V041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V041
|
| Hospital Charge Code |
2362
|
| 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
|
|
|
047V04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V04Z
|
| Hospital Charge Code |
2363
|
| 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
|
|
|
047V05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V05Z
|
| Hospital Charge Code |
2364
|
| 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
|
|
|
047V06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V06Z
|
| Hospital Charge Code |
2365
|
| 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
|
|
|
047V07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V07Z
|
| Hospital Charge Code |
2366
|
| 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
|
|
|
047V0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V0D1
|
| Hospital Charge Code |
4571
|
| 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
|
|
|
047V0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V0D6
|
| Hospital Charge Code |
4572
|
| 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
|
|
