|
047W45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W45Z
|
| Hospital Charge Code |
2389
|
| 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
|
|
|
047W46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W46Z
|
| Hospital Charge Code |
2390
|
| 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
|
|
|
047W47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047W47Z
|
| Hospital Charge Code |
2391
|
| 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
|
|
|
047W4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W4D1
|
| Hospital Charge Code |
4601
|
| 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
|
|
|
047W4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W4D6
|
| Hospital Charge Code |
4602
|
| 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
|
|
|
047W4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W4DZ
|
| Hospital Charge Code |
4603
|
| 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
|
|
|
047W4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W4EZ
|
| Hospital Charge Code |
4604
|
| 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
|
|
|
047W4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W4FZ
|
| Hospital Charge Code |
4605
|
| 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
|
|
|
047W4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047W4GZ
|
| Hospital Charge Code |
4606
|
| 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
|
|
|
047Y041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y041
|
| Hospital Charge Code |
2392
|
| 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
|
|
|
047Y04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y04Z
|
| Hospital Charge Code |
2393
|
| 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
|
|
|
047Y05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y05Z
|
| Hospital Charge Code |
2394
|
| 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
|
|
|
047Y06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y06Z
|
| Hospital Charge Code |
2395
|
| 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
|
|
|
047Y07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y07Z
|
| Hospital Charge Code |
2396
|
| 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
|
|
|
047Y0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y0D1
|
| Hospital Charge Code |
4607
|
| 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
|
|
|
047Y0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y0D6
|
| Hospital Charge Code |
4608
|
| 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
|
|
|
047Y0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y0DZ
|
| Hospital Charge Code |
4609
|
| 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
|
|
|
047Y0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y0EZ
|
| Hospital Charge Code |
4610
|
| 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
|
|
|
047Y0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y0FZ
|
| Hospital Charge Code |
4611
|
| 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
|
|
|
047Y0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y0GZ
|
| Hospital Charge Code |
4612
|
| 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
|
|
|
047Y341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y341
|
| Hospital Charge Code |
2397
|
| 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
|
|
|
047Y34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y34Z
|
| Hospital Charge Code |
2398
|
| 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
|
|
|
047Y35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y35Z
|
| Hospital Charge Code |
2399
|
| 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
|
|
|
047Y36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y36Z
|
| Hospital Charge Code |
2400
|
| 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
|
|
|
047Y37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y37Z
|
| Hospital Charge Code |
2401
|
| 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
|
|
