|
047K0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K0FZ
|
| Hospital Charge Code |
4396
|
| 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
|
|
|
047K0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K0GZ
|
| Hospital Charge Code |
4397
|
| 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
|
|
|
047K341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K341
|
| Hospital Charge Code |
2216
|
| 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
|
|
|
047K34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K34Z
|
| Hospital Charge Code |
2217
|
| 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
|
|
|
047K35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K35Z
|
| Hospital Charge Code |
2218
|
| 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
|
|
|
047K36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K36Z
|
| Hospital Charge Code |
2219
|
| 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
|
|
|
047K37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K37Z
|
| Hospital Charge Code |
2220
|
| 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
|
|
|
047K3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K3D1
|
| Hospital Charge Code |
4398
|
| 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
|
|
|
047K3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K3D6
|
| Hospital Charge Code |
4399
|
| 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
|
|
|
047K3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K3DZ
|
| Hospital Charge Code |
4400
|
| 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
|
|
|
047K3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K3EZ
|
| Hospital Charge Code |
4401
|
| 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
|
|
|
047K3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K3FZ
|
| Hospital Charge Code |
4402
|
| 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
|
|
|
047K3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K3GZ
|
| Hospital Charge Code |
4403
|
| 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
|
|
|
047K441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K441
|
| Hospital Charge Code |
2221
|
| 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
|
|
|
047K44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K44Z
|
| Hospital Charge Code |
2222
|
| 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
|
|
|
047K45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K45Z
|
| Hospital Charge Code |
2223
|
| 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
|
|
|
047K46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K46Z
|
| Hospital Charge Code |
2224
|
| 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
|
|
|
047K47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047K47Z
|
| Hospital Charge Code |
2225
|
| 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
|
|
|
047K4D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K4D1
|
| Hospital Charge Code |
4404
|
| 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
|
|
|
047K4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K4D6
|
| Hospital Charge Code |
4405
|
| 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
|
|
|
047K4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K4DZ
|
| Hospital Charge Code |
4406
|
| 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
|
|
|
047K4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K4EZ
|
| Hospital Charge Code |
4407
|
| 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
|
|
|
047K4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K4FZ
|
| Hospital Charge Code |
4408
|
| 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
|
|
|
047K4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047K4GZ
|
| Hospital Charge Code |
4409
|
| 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
|
|
|
047L041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L041
|
| Hospital Charge Code |
2226
|
| 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
|
|
