|
047E3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E3D1
|
| Hospital Charge Code |
4326
|
| 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
|
|
|
047E3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E3D6
|
| Hospital Charge Code |
4327
|
| 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
|
|
|
047E3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E3DZ
|
| Hospital Charge Code |
4328
|
| 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
|
|
|
047E3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E3EZ
|
| Hospital Charge Code |
4329
|
| 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
|
|
|
047E3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E3FZ
|
| Hospital Charge Code |
4330
|
| 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
|
|
|
047E3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E3GZ
|
| Hospital Charge Code |
4331
|
| 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
|
|
|
047E441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047E441
|
| Hospital Charge Code |
2161
|
| 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
|
|
|
047E44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047E44Z
|
| Hospital Charge Code |
2162
|
| 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
|
|
|
047E45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047E45Z
|
| Hospital Charge Code |
2163
|
| 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
|
|
|
047E46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047E46Z
|
| Hospital Charge Code |
2164
|
| 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
|
|
|
047E47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047E47Z
|
| Hospital Charge Code |
2165
|
| 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
|
|
|
047E4D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E4D1
|
| Hospital Charge Code |
4332
|
| 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
|
|
|
047E4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E4D6
|
| Hospital Charge Code |
4333
|
| 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
|
|
|
047E4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E4DZ
|
| Hospital Charge Code |
4334
|
| 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
|
|
|
047E4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E4EZ
|
| Hospital Charge Code |
4335
|
| 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
|
|
|
047E4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E4FZ
|
| Hospital Charge Code |
4336
|
| 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
|
|
|
047E4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047E4GZ
|
| Hospital Charge Code |
4337
|
| 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
|
|
|
047F041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047F041
|
| Hospital Charge Code |
2166
|
| 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
|
|
|
047F04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047F04Z
|
| Hospital Charge Code |
2167
|
| 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
|
|
|
047F05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047F05Z
|
| Hospital Charge Code |
2168
|
| 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
|
|
|
047F06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047F06Z
|
| Hospital Charge Code |
2169
|
| 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
|
|
|
047F07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047F07Z
|
| Hospital Charge Code |
2170
|
| 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
|
|
|
047F0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047F0D1
|
| Hospital Charge Code |
4338
|
| 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
|
|
|
047F0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047F0D6
|
| Hospital Charge Code |
4339
|
| 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
|
|
|
047F0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047F0DZ
|
| Hospital Charge Code |
4340
|
| 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
|
|
