|
047T3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T3FZ
|
| Hospital Charge Code |
4545
|
| 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
|
|
|
047T3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T3GZ
|
| Hospital Charge Code |
4546
|
| 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
|
|
|
047T441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047T441
|
| Hospital Charge Code |
2342
|
| 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
|
|
|
047T44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047T44Z
|
| Hospital Charge Code |
2343
|
| 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
|
|
|
047T45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047T45Z
|
| Hospital Charge Code |
2344
|
| 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
|
|
|
047T46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047T46Z
|
| Hospital Charge Code |
2345
|
| 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
|
|
|
047T47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047T47Z
|
| Hospital Charge Code |
2346
|
| 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
|
|
|
047T4D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T4D1
|
| Hospital Charge Code |
4547
|
| 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
|
|
|
047T4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T4D6
|
| Hospital Charge Code |
4548
|
| 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
|
|
|
047T4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T4DZ
|
| Hospital Charge Code |
4549
|
| 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
|
|
|
047T4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T4EZ
|
| Hospital Charge Code |
4550
|
| 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
|
|
|
047T4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T4FZ
|
| Hospital Charge Code |
4551
|
| 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
|
|
|
047T4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047T4GZ
|
| Hospital Charge Code |
4552
|
| 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
|
|
|
047U041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047U041
|
| Hospital Charge Code |
2347
|
| 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
|
|
|
047U04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047U04Z
|
| Hospital Charge Code |
2348
|
| 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
|
|
|
047U05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047U05Z
|
| Hospital Charge Code |
2349
|
| 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
|
|
|
047U06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047U06Z
|
| Hospital Charge Code |
2350
|
| 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
|
|
|
047U07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047U07Z
|
| Hospital Charge Code |
2351
|
| 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
|
|
|
047U0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047U0D1
|
| Hospital Charge Code |
4553
|
| 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
|
|
|
047U0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047U0D6
|
| Hospital Charge Code |
4554
|
| 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
|
|
|
047U0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047U0DZ
|
| Hospital Charge Code |
4555
|
| 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
|
|
|
047U0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047U0EZ
|
| Hospital Charge Code |
4556
|
| 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
|
|
|
047U0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047U0FZ
|
| Hospital Charge Code |
4557
|
| 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
|
|
|
047U0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 047U0GZ
|
| Hospital Charge Code |
4558
|
| 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
|
|
|
047U341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047U341
|
| Hospital Charge Code |
2352
|
| 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
|
|
