|
047B37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047B37Z
|
| Hospital Charge Code |
2116
|
| 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
|
|
|
047B3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B3D1
|
| Hospital Charge Code |
4271
|
| 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
|
|
|
047B3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B3D6
|
| Hospital Charge Code |
4272
|
| 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
|
|
|
047B3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B3DZ
|
| Hospital Charge Code |
4273
|
| 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
|
|
|
047B3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B3EZ
|
| Hospital Charge Code |
4274
|
| 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
|
|
|
047B3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B3FZ
|
| Hospital Charge Code |
4275
|
| 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
|
|
|
047B3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B3GZ
|
| Hospital Charge Code |
4276
|
| 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
|
|
|
047B441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047B441
|
| Hospital Charge Code |
2117
|
| 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
|
|
|
047B44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047B44Z
|
| Hospital Charge Code |
2118
|
| 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
|
|
|
047B45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047B45Z
|
| Hospital Charge Code |
2119
|
| 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
|
|
|
047B46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047B46Z
|
| Hospital Charge Code |
2120
|
| 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
|
|
|
047B47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047B47Z
|
| Hospital Charge Code |
2121
|
| 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
|
|
|
047B4D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B4D1
|
| Hospital Charge Code |
4277
|
| 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
|
|
|
047B4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B4D6
|
| Hospital Charge Code |
4278
|
| 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
|
|
|
047B4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B4DZ
|
| Hospital Charge Code |
4279
|
| 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
|
|
|
047B4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B4EZ
|
| Hospital Charge Code |
4280
|
| 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
|
|
|
047B4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B4FZ
|
| Hospital Charge Code |
4281
|
| 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
|
|
|
047B4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047B4GZ
|
| Hospital Charge Code |
4282
|
| 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
|
|
|
047C041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C041
|
| Hospital Charge Code |
2122
|
| 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
|
|
|
047C04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C04Z
|
| Hospital Charge Code |
2123
|
| 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
|
|
|
047C05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C05Z
|
| Hospital Charge Code |
2124
|
| 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
|
|
|
047C06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C06Z
|
| Hospital Charge Code |
2125
|
| 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
|
|
|
047C07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C07Z
|
| Hospital Charge Code |
2126
|
| 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
|
|
|
047C0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C0D1
|
| Hospital Charge Code |
4283
|
| 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
|
|
|
047C0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C0D6
|
| Hospital Charge Code |
4284
|
| 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
|
|
