|
047L04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L04Z
|
| Hospital Charge Code |
2227
|
| 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
|
|
|
047L05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L05Z
|
| Hospital Charge Code |
2228
|
| 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
|
|
|
047L06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L06Z
|
| Hospital Charge Code |
2229
|
| 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
|
|
|
047L07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L07Z
|
| Hospital Charge Code |
2230
|
| 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
|
|
|
047L0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L0D1
|
| Hospital Charge Code |
4410
|
| 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
|
|
|
047L0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L0D6
|
| Hospital Charge Code |
4411
|
| 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
|
|
|
047L0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L0DZ
|
| Hospital Charge Code |
4412
|
| 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
|
|
|
047L0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L0EZ
|
| Hospital Charge Code |
4413
|
| 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
|
|
|
047L0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L0FZ
|
| Hospital Charge Code |
4414
|
| 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
|
|
|
047L0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L0GZ
|
| Hospital Charge Code |
4415
|
| 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
|
|
|
047L341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L341
|
| Hospital Charge Code |
2231
|
| 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
|
|
|
047L34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L34Z
|
| Hospital Charge Code |
2232
|
| 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
|
|
|
047L35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L35Z
|
| Hospital Charge Code |
2233
|
| 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
|
|
|
047L36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L36Z
|
| Hospital Charge Code |
2234
|
| 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
|
|
|
047L37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L37Z
|
| Hospital Charge Code |
2235
|
| 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
|
|
|
047L3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L3D1
|
| Hospital Charge Code |
4416
|
| 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
|
|
|
047L3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L3D6
|
| Hospital Charge Code |
4417
|
| 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
|
|
|
047L3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L3DZ
|
| Hospital Charge Code |
4418
|
| 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
|
|
|
047L3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L3EZ
|
| Hospital Charge Code |
4419
|
| 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
|
|
|
047L3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L3FZ
|
| Hospital Charge Code |
4420
|
| 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
|
|
|
047L3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047L3GZ
|
| Hospital Charge Code |
4421
|
| 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
|
|
|
047L441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L441
|
| Hospital Charge Code |
2236
|
| 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
|
|
|
047L44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L44Z
|
| Hospital Charge Code |
2237
|
| 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
|
|
|
047L45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L45Z
|
| Hospital Charge Code |
2238
|
| 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
|
|
|
047L46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047L46Z
|
| Hospital Charge Code |
2239
|
| 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
|
|
