|
04794FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04794FZ
|
| Hospital Charge Code |
4245
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04794GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04794GZ
|
| Hospital Charge Code |
4246
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A041
|
| Hospital Charge Code |
2092
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A04Z
|
| Hospital Charge Code |
2093
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A05Z
|
| Hospital Charge Code |
2094
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A06Z
|
| Hospital Charge Code |
2095
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A07Z
|
| Hospital Charge Code |
2096
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A0D1
|
| Hospital Charge Code |
4247
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A0D6
|
| Hospital Charge Code |
4248
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A0DZ
|
| Hospital Charge Code |
4249
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A0EZ
|
| Hospital Charge Code |
4250
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A0FZ
|
| Hospital Charge Code |
4251
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A0GZ
|
| Hospital Charge Code |
4252
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A341
|
| Hospital Charge Code |
2097
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A34Z
|
| Hospital Charge Code |
2098
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A35Z
|
| Hospital Charge Code |
2099
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A36Z
|
| Hospital Charge Code |
2100
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A37Z
|
| Hospital Charge Code |
2101
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047A3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A3D1
|
| Hospital Charge Code |
4253
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A3D6
|
| Hospital Charge Code |
4254
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A3DZ
|
| Hospital Charge Code |
4255
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A3EZ
|
| Hospital Charge Code |
4256
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A3FZ
|
| Hospital Charge Code |
4257
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047A3GZ
|
| Hospital Charge Code |
4258
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
047A441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047A441
|
| Hospital Charge Code |
2102
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
