|
047V4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047V4GZ
|
| Hospital Charge Code |
4588
|
| 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
|
|
|
047W041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W041
|
| Hospital Charge Code |
2377
|
| 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
|
|
|
047W04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W04Z
|
| Hospital Charge Code |
2378
|
| 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
|
|
|
047W05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W05Z
|
| Hospital Charge Code |
2379
|
| 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
|
|
|
047W06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W06Z
|
| Hospital Charge Code |
2380
|
| 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
|
|
|
047W07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W07Z
|
| Hospital Charge Code |
2381
|
| 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
|
|
|
047W0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W0D1
|
| Hospital Charge Code |
4589
|
| 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
|
|
|
047W0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W0D6
|
| Hospital Charge Code |
4590
|
| 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
|
|
|
047W0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W0DZ
|
| Hospital Charge Code |
4591
|
| 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
|
|
|
047W0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W0EZ
|
| Hospital Charge Code |
4592
|
| 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
|
|
|
047W0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W0FZ
|
| Hospital Charge Code |
4593
|
| 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
|
|
|
047W0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W0GZ
|
| Hospital Charge Code |
4594
|
| 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
|
|
|
047W341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W341
|
| Hospital Charge Code |
2382
|
| 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
|
|
|
047W34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W34Z
|
| Hospital Charge Code |
2383
|
| 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
|
|
|
047W35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W35Z
|
| Hospital Charge Code |
2384
|
| 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
|
|
|
047W36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W36Z
|
| Hospital Charge Code |
2385
|
| 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
|
|
|
047W37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W37Z
|
| Hospital Charge Code |
2386
|
| 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
|
|
|
047W3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W3D1
|
| Hospital Charge Code |
4595
|
| 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
|
|
|
047W3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W3D6
|
| Hospital Charge Code |
4596
|
| 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
|
|
|
047W3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W3DZ
|
| Hospital Charge Code |
4597
|
| 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
|
|
|
047W3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W3EZ
|
| Hospital Charge Code |
4598
|
| 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
|
|
|
047W3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W3FZ
|
| Hospital Charge Code |
4599
|
| 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
|
|
|
047W3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W3GZ
|
| Hospital Charge Code |
4600
|
| 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
|
|
|
047W441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W441
|
| Hospital Charge Code |
2387
|
| 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
|
|
|
047W44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W44Z
|
| Hospital Charge Code |
2388
|
| 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
|
|
