|
047237Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047237Z
|
| Hospital Charge Code |
1981
|
| 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
|
|
|
04723D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04723D1
|
| Hospital Charge Code |
4109
|
| 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
|
|
|
04723D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04723D6
|
| Hospital Charge Code |
4110
|
| 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
|
|
|
04723DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04723DZ
|
| Hospital Charge Code |
4111
|
| 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
|
|
|
04723EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04723EZ
|
| Hospital Charge Code |
4112
|
| 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
|
|
|
04723FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04723FZ
|
| Hospital Charge Code |
4113
|
| 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
|
|
|
04723GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04723GZ
|
| Hospital Charge Code |
4114
|
| 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
|
|
|
0472441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0472441
|
| Hospital Charge Code |
1982
|
| 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
|
|
|
047244Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047244Z
|
| Hospital Charge Code |
1983
|
| 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
|
|
|
047245Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047245Z
|
| Hospital Charge Code |
1984
|
| 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
|
|
|
047246Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047246Z
|
| Hospital Charge Code |
1985
|
| 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
|
|
|
047247Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047247Z
|
| Hospital Charge Code |
1986
|
| 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
|
|
|
04724D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04724D1
|
| Hospital Charge Code |
4115
|
| 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
|
|
|
04724D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04724D6
|
| Hospital Charge Code |
4116
|
| 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
|
|
|
04724DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04724DZ
|
| Hospital Charge Code |
4117
|
| 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
|
|
|
04724EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04724EZ
|
| Hospital Charge Code |
4118
|
| 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
|
|
|
04724FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04724FZ
|
| Hospital Charge Code |
4119
|
| 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
|
|
|
04724GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04724GZ
|
| Hospital Charge Code |
4120
|
| 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
|
|
|
0473041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0473041
|
| Hospital Charge Code |
1987
|
| 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
|
|
|
047304Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047304Z
|
| Hospital Charge Code |
1988
|
| 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
|
|
|
047305Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047305Z
|
| Hospital Charge Code |
1989
|
| 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
|
|
|
047306Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047306Z
|
| Hospital Charge Code |
1990
|
| 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
|
|
|
047307Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047307Z
|
| Hospital Charge Code |
1991
|
| 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
|
|
|
04730D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04730D1
|
| Hospital Charge Code |
4121
|
| 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
|
|
|
04730D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04730D6
|
| Hospital Charge Code |
4122
|
| 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
|
|
