|
047P05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P05Z
|
| Hospital Charge Code |
2274
|
| 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
|
|
|
047P06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P06Z
|
| Hospital Charge Code |
2275
|
| 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
|
|
|
047P07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P07Z
|
| Hospital Charge Code |
2276
|
| 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
|
|
|
047P0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P0D1
|
| Hospital Charge Code |
4463
|
| 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
|
|
|
047P0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P0D6
|
| Hospital Charge Code |
4464
|
| 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
|
|
|
047P0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P0DZ
|
| Hospital Charge Code |
4465
|
| 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
|
|
|
047P0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P0EZ
|
| Hospital Charge Code |
4466
|
| 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
|
|
|
047P0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P0FZ
|
| Hospital Charge Code |
4467
|
| 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
|
|
|
047P0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P0GZ
|
| Hospital Charge Code |
4468
|
| 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
|
|
|
047P341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P341
|
| Hospital Charge Code |
2277
|
| 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
|
|
|
047P34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P34Z
|
| Hospital Charge Code |
2278
|
| 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
|
|
|
047P35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P35Z
|
| Hospital Charge Code |
2279
|
| 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
|
|
|
047P36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P36Z
|
| Hospital Charge Code |
2280
|
| 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
|
|
|
047P37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P37Z
|
| Hospital Charge Code |
2281
|
| 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
|
|
|
047P3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P3D1
|
| Hospital Charge Code |
4469
|
| 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
|
|
|
047P3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P3D6
|
| Hospital Charge Code |
4470
|
| 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
|
|
|
047P3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P3DZ
|
| Hospital Charge Code |
4471
|
| 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
|
|
|
047P3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P3EZ
|
| Hospital Charge Code |
4472
|
| 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
|
|
|
047P3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P3FZ
|
| Hospital Charge Code |
4473
|
| 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
|
|
|
047P3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047P3GZ
|
| Hospital Charge Code |
4474
|
| 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
|
|
|
047P441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P441
|
| Hospital Charge Code |
2282
|
| 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
|
|
|
047P44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P44Z
|
| Hospital Charge Code |
2283
|
| 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
|
|
|
047P45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P45Z
|
| Hospital Charge Code |
2284
|
| 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
|
|
|
047P46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P46Z
|
| Hospital Charge Code |
2285
|
| 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
|
|
|
047P47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047P47Z
|
| Hospital Charge Code |
2286
|
| 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
|
|
