|
047Y3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y3D1
|
| Hospital Charge Code |
4613
|
| 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
|
|
|
047Y3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y3D6
|
| Hospital Charge Code |
4614
|
| 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
|
|
|
047Y3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y3DZ
|
| Hospital Charge Code |
4615
|
| 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
|
|
|
047Y3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y3EZ
|
| Hospital Charge Code |
4616
|
| 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
|
|
|
047Y3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y3FZ
|
| Hospital Charge Code |
4617
|
| 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
|
|
|
047Y3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y3GZ
|
| Hospital Charge Code |
4618
|
| 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
|
|
|
047Y441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y441
|
| Hospital Charge Code |
2402
|
| 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
|
|
|
047Y44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y44Z
|
| Hospital Charge Code |
2403
|
| 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
|
|
|
047Y45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y45Z
|
| Hospital Charge Code |
2404
|
| 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
|
|
|
047Y46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y46Z
|
| Hospital Charge Code |
2405
|
| 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
|
|
|
047Y47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047Y47Z
|
| Hospital Charge Code |
2406
|
| 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
|
|
|
047Y4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y4D1
|
| Hospital Charge Code |
4619
|
| 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
|
|
|
047Y4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y4D6
|
| Hospital Charge Code |
4620
|
| 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
|
|
|
047Y4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y4DZ
|
| Hospital Charge Code |
4621
|
| 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
|
|
|
047Y4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y4EZ
|
| Hospital Charge Code |
4622
|
| 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
|
|
|
047Y4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y4FZ
|
| Hospital Charge Code |
4623
|
| 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
|
|
|
047Y4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047Y4GZ
|
| Hospital Charge Code |
4624
|
| 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
|
|
|
04C03ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C03ZZ
|
| Hospital Charge Code |
2407
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04C13ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C13ZZ
|
| Hospital Charge Code |
2408
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04C23ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C23ZZ
|
| Hospital Charge Code |
2409
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04C33ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C33ZZ
|
| Hospital Charge Code |
2410
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04C43ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C43ZZ
|
| Hospital Charge Code |
2411
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04C53ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C53ZZ
|
| Hospital Charge Code |
2412
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04C63ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C63ZZ
|
| Hospital Charge Code |
2413
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04C73ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 04C73ZZ
|
| Hospital Charge Code |
2414
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
