|
04700D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04700D6
|
| Hospital Charge Code |
4068
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04700DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04700DZ
|
| Hospital Charge Code |
4069
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04700EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04700EZ
|
| Hospital Charge Code |
4070
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04700FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04700FZ
|
| Hospital Charge Code |
4071
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04700GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04700GZ
|
| Hospital Charge Code |
4072
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
0470341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0470341
|
| Hospital Charge Code |
1947
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047034Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047034Z
|
| Hospital Charge Code |
1948
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047035Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047035Z
|
| Hospital Charge Code |
1949
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047036Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047036Z
|
| Hospital Charge Code |
1950
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047037Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047037Z
|
| Hospital Charge Code |
1951
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
04703D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04703D1
|
| Hospital Charge Code |
4073
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04703D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04703D6
|
| Hospital Charge Code |
4074
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04703DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04703DZ
|
| Hospital Charge Code |
4075
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04703EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04703EZ
|
| Hospital Charge Code |
4076
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04703FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04703FZ
|
| Hospital Charge Code |
4077
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04703GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04703GZ
|
| Hospital Charge Code |
4078
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
0470441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0470441
|
| Hospital Charge Code |
1952
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047044Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047044Z
|
| Hospital Charge Code |
1953
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047045Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047045Z
|
| Hospital Charge Code |
1954
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047046Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047046Z
|
| Hospital Charge Code |
1955
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047047Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047047Z
|
| Hospital Charge Code |
1956
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
04704D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04704D1
|
| Hospital Charge Code |
4079
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04704D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04704D6
|
| Hospital Charge Code |
4080
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04704DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04704DZ
|
| Hospital Charge Code |
4081
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
04704EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04704EZ
|
| Hospital Charge Code |
4082
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
