|
04704FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04704FZ
|
| Hospital Charge Code |
4083
|
| 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
|
|
|
04704GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04704GZ
|
| Hospital Charge Code |
4084
|
| 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
|
|
|
0471041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0471041
|
| Hospital Charge Code |
1957
|
| 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
|
|
|
047104Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047104Z
|
| Hospital Charge Code |
1958
|
| 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
|
|
|
047105Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047105Z
|
| Hospital Charge Code |
1959
|
| 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
|
|
|
047106Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047106Z
|
| Hospital Charge Code |
1960
|
| 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
|
|
|
047107Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047107Z
|
| Hospital Charge Code |
1961
|
| 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
|
|
|
04710D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04710D1
|
| Hospital Charge Code |
4085
|
| 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
|
|
|
04710D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04710D6
|
| Hospital Charge Code |
4086
|
| 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
|
|
|
04710DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04710DZ
|
| Hospital Charge Code |
4087
|
| 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
|
|
|
04710EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04710EZ
|
| Hospital Charge Code |
4088
|
| 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
|
|
|
04710FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04710FZ
|
| Hospital Charge Code |
4089
|
| 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
|
|
|
04710GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04710GZ
|
| Hospital Charge Code |
4090
|
| 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
|
|
|
0471341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0471341
|
| Hospital Charge Code |
1962
|
| 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
|
|
|
047134Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047134Z
|
| Hospital Charge Code |
1963
|
| 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
|
|
|
047135Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047135Z
|
| Hospital Charge Code |
1964
|
| 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
|
|
|
047136Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047136Z
|
| Hospital Charge Code |
1965
|
| 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
|
|
|
047137Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047137Z
|
| Hospital Charge Code |
1966
|
| 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
|
|
|
04713D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04713D1
|
| Hospital Charge Code |
4091
|
| 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
|
|
|
04713D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04713D6
|
| Hospital Charge Code |
4092
|
| 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
|
|
|
04713DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04713DZ
|
| Hospital Charge Code |
4093
|
| 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
|
|
|
04713EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04713EZ
|
| Hospital Charge Code |
4094
|
| 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
|
|
|
04713FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04713FZ
|
| Hospital Charge Code |
4095
|
| 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
|
|
|
04713GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04713GZ
|
| Hospital Charge Code |
4096
|
| 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
|
|
|
0471441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0471441
|
| Hospital Charge Code |
1967
|
| 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
|
|
