|
047C0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C0DZ
|
| Hospital Charge Code |
4285
|
| 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
|
|
|
047C0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C0EZ
|
| Hospital Charge Code |
4286
|
| 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
|
|
|
047C0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C0FZ
|
| Hospital Charge Code |
4287
|
| 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
|
|
|
047C0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C0GZ
|
| Hospital Charge Code |
4288
|
| 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
|
|
|
047C341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C341
|
| Hospital Charge Code |
2127
|
| 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
|
|
|
047C34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C34Z
|
| Hospital Charge Code |
2128
|
| 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
|
|
|
047C35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C35Z
|
| Hospital Charge Code |
2129
|
| 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
|
|
|
047C36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C36Z
|
| Hospital Charge Code |
2130
|
| 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
|
|
|
047C37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C37Z
|
| Hospital Charge Code |
2131
|
| 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
|
|
|
047C3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C3D1
|
| Hospital Charge Code |
4289
|
| 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
|
|
|
047C3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C3D6
|
| Hospital Charge Code |
4290
|
| 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
|
|
|
047C3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C3DZ
|
| Hospital Charge Code |
4291
|
| 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
|
|
|
047C3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C3EZ
|
| Hospital Charge Code |
4292
|
| 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
|
|
|
047C3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C3FZ
|
| Hospital Charge Code |
4293
|
| 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
|
|
|
047C3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C3GZ
|
| Hospital Charge Code |
4294
|
| 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
|
|
|
047C441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C441
|
| Hospital Charge Code |
2132
|
| 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
|
|
|
047C44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C44Z
|
| Hospital Charge Code |
2133
|
| 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
|
|
|
047C45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C45Z
|
| Hospital Charge Code |
2134
|
| 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
|
|
|
047C46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C46Z
|
| Hospital Charge Code |
2135
|
| 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
|
|
|
047C47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047C47Z
|
| Hospital Charge Code |
2136
|
| 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
|
|
|
047C4D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C4D1
|
| Hospital Charge Code |
4295
|
| 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
|
|
|
047C4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C4D6
|
| Hospital Charge Code |
4296
|
| 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
|
|
|
047C4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C4DZ
|
| Hospital Charge Code |
4297
|
| 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
|
|
|
047C4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C4EZ
|
| Hospital Charge Code |
4298
|
| 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
|
|
|
047C4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047C4FZ
|
| Hospital Charge Code |
4299
|
| 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
|
|
