|
047N0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N0GZ
|
| Hospital Charge Code |
4450
|
| 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
|
|
|
047N341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N341
|
| Hospital Charge Code |
2262
|
| 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
|
|
|
047N34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N34Z
|
| Hospital Charge Code |
2263
|
| 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
|
|
|
047N35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N35Z
|
| Hospital Charge Code |
2264
|
| 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
|
|
|
047N36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N36Z
|
| Hospital Charge Code |
2265
|
| 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
|
|
|
047N37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N37Z
|
| Hospital Charge Code |
2266
|
| 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
|
|
|
047N3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N3D1
|
| Hospital Charge Code |
4451
|
| 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
|
|
|
047N3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N3D6
|
| Hospital Charge Code |
4452
|
| 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
|
|
|
047N3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N3DZ
|
| Hospital Charge Code |
4453
|
| 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
|
|
|
047N3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N3EZ
|
| Hospital Charge Code |
4454
|
| 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
|
|
|
047N3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N3FZ
|
| Hospital Charge Code |
4455
|
| 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
|
|
|
047N3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N3GZ
|
| Hospital Charge Code |
4456
|
| 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
|
|
|
047N441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N441
|
| Hospital Charge Code |
2267
|
| 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
|
|
|
047N44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N44Z
|
| Hospital Charge Code |
2268
|
| 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
|
|
|
047N45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N45Z
|
| Hospital Charge Code |
2269
|
| 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
|
|
|
047N46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N46Z
|
| Hospital Charge Code |
2270
|
| 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
|
|
|
047N47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047N47Z
|
| Hospital Charge Code |
2271
|
| 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
|
|
|
047N4D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N4D1
|
| Hospital Charge Code |
4457
|
| 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
|
|
|
047N4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N4D6
|
| Hospital Charge Code |
4458
|
| 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
|
|
|
047N4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N4DZ
|
| Hospital Charge Code |
4459
|
| 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
|
|
|
047N4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N4EZ
|
| Hospital Charge Code |
4460
|
| 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
|
|
|
047N4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N4FZ
|
| Hospital Charge Code |
4461
|
| 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
|
|
|
047N4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047N4GZ
|
| Hospital Charge Code |
4462
|
| 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
|
|
|
047P041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P041
|
| Hospital Charge Code |
2272
|
| 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
|
|
|
047P04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P04Z
|
| Hospital Charge Code |
2273
|
| 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
|
|
