|
047V0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V0DZ
|
| Hospital Charge Code |
4573
|
| 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
|
|
|
047V0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V0EZ
|
| Hospital Charge Code |
4574
|
| 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
|
|
|
047V0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V0FZ
|
| Hospital Charge Code |
4575
|
| 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
|
|
|
047V0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V0GZ
|
| Hospital Charge Code |
4576
|
| 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
|
|
|
047V341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V341
|
| Hospital Charge Code |
2367
|
| 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
|
|
|
047V34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V34Z
|
| Hospital Charge Code |
2368
|
| 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
|
|
|
047V35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V35Z
|
| Hospital Charge Code |
2369
|
| 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
|
|
|
047V36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V36Z
|
| Hospital Charge Code |
2370
|
| 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
|
|
|
047V37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V37Z
|
| Hospital Charge Code |
2371
|
| 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
|
|
|
047V3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V3D1
|
| Hospital Charge Code |
4577
|
| 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
|
|
|
047V3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V3D6
|
| Hospital Charge Code |
4578
|
| 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
|
|
|
047V3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V3DZ
|
| Hospital Charge Code |
4579
|
| 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
|
|
|
047V3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V3EZ
|
| Hospital Charge Code |
4580
|
| 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
|
|
|
047V3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V3FZ
|
| Hospital Charge Code |
4581
|
| 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
|
|
|
047V3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V3GZ
|
| Hospital Charge Code |
4582
|
| 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
|
|
|
047V441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V441
|
| Hospital Charge Code |
2372
|
| 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
|
|
|
047V44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V44Z
|
| Hospital Charge Code |
2373
|
| 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
|
|
|
047V45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V45Z
|
| Hospital Charge Code |
2374
|
| 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
|
|
|
047V46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V46Z
|
| Hospital Charge Code |
2375
|
| 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
|
|
|
047V47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047V47Z
|
| Hospital Charge Code |
2376
|
| 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
|
|
|
047V4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V4D1
|
| Hospital Charge Code |
4583
|
| 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
|
|
|
047V4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V4D6
|
| Hospital Charge Code |
4584
|
| 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
|
|
|
047V4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V4DZ
|
| Hospital Charge Code |
4585
|
| 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
|
|
|
047V4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V4EZ
|
| Hospital Charge Code |
4586
|
| 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
|
|
|
047V4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V4FZ
|
| Hospital Charge Code |
4587
|
| 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
|
|
