|
04730DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04730DZ
|
| Hospital Charge Code |
4123
|
| 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
|
|
|
04730EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04730EZ
|
| Hospital Charge Code |
4124
|
| 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
|
|
|
04730FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04730FZ
|
| Hospital Charge Code |
4125
|
| 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
|
|
|
04730GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04730GZ
|
| Hospital Charge Code |
4126
|
| 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
|
|
|
0473341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0473341
|
| Hospital Charge Code |
1992
|
| 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
|
|
|
047334Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047334Z
|
| Hospital Charge Code |
1993
|
| 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
|
|
|
047335Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047335Z
|
| Hospital Charge Code |
1994
|
| 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
|
|
|
047336Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047336Z
|
| Hospital Charge Code |
1995
|
| 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
|
|
|
047337Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047337Z
|
| Hospital Charge Code |
1996
|
| 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
|
|
|
04733D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04733D1
|
| Hospital Charge Code |
4127
|
| 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
|
|
|
04733D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04733D6
|
| Hospital Charge Code |
4128
|
| 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
|
|
|
04733DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04733DZ
|
| Hospital Charge Code |
4129
|
| 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
|
|
|
04733EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04733EZ
|
| Hospital Charge Code |
4130
|
| 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
|
|
|
04733FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04733FZ
|
| Hospital Charge Code |
4131
|
| 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
|
|
|
04733GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04733GZ
|
| Hospital Charge Code |
4132
|
| 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
|
|
|
0473441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0473441
|
| Hospital Charge Code |
1997
|
| 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
|
|
|
047344Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047344Z
|
| Hospital Charge Code |
1998
|
| 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
|
|
|
047345Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047345Z
|
| Hospital Charge Code |
1999
|
| 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
|
|
|
047346Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047346Z
|
| Hospital Charge Code |
2000
|
| 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
|
|
|
047347Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047347Z
|
| Hospital Charge Code |
2001
|
| 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
|
|
|
04734D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04734D1
|
| Hospital Charge Code |
4133
|
| 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
|
|
|
04734D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04734D6
|
| Hospital Charge Code |
4134
|
| 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
|
|
|
04734DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04734DZ
|
| Hospital Charge Code |
4135
|
| 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
|
|
|
04734EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04734EZ
|
| Hospital Charge Code |
4136
|
| 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
|
|
|
04734FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04734FZ
|
| Hospital Charge Code |
4137
|
| 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
|
|
