|
04760EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04760EZ
|
| Hospital Charge Code |
4178
|
| 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
|
|
|
04760FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04760FZ
|
| Hospital Charge Code |
4179
|
| 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
|
|
|
04760GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04760GZ
|
| Hospital Charge Code |
4180
|
| 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
|
|
|
0476341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0476341
|
| Hospital Charge Code |
2037
|
| 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
|
|
|
047634Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047634Z
|
| Hospital Charge Code |
2038
|
| 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
|
|
|
047635Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047635Z
|
| Hospital Charge Code |
2039
|
| 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
|
|
|
047636Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047636Z
|
| Hospital Charge Code |
2040
|
| 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
|
|
|
047637Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047637Z
|
| Hospital Charge Code |
2041
|
| 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
|
|
|
04763D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04763D1
|
| Hospital Charge Code |
4181
|
| 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
|
|
|
04763D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04763D6
|
| Hospital Charge Code |
4182
|
| 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
|
|
|
04763DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04763DZ
|
| Hospital Charge Code |
4183
|
| 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
|
|
|
04763EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04763EZ
|
| Hospital Charge Code |
4184
|
| 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
|
|
|
04763FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04763FZ
|
| Hospital Charge Code |
4185
|
| 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
|
|
|
04763GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04763GZ
|
| Hospital Charge Code |
4186
|
| 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
|
|
|
0476441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0476441
|
| Hospital Charge Code |
2042
|
| 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
|
|
|
047644Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047644Z
|
| Hospital Charge Code |
2043
|
| 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
|
|
|
047645Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047645Z
|
| Hospital Charge Code |
2044
|
| 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
|
|
|
047646Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047646Z
|
| Hospital Charge Code |
2045
|
| 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
|
|
|
047647Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047647Z
|
| Hospital Charge Code |
2046
|
| 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
|
|
|
04764D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04764D1
|
| Hospital Charge Code |
4187
|
| 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
|
|
|
04764D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04764D6
|
| Hospital Charge Code |
4188
|
| 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
|
|
|
04764DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04764DZ
|
| Hospital Charge Code |
4189
|
| 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
|
|
|
04764EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04764EZ
|
| Hospital Charge Code |
4190
|
| 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
|
|
|
04764FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04764FZ
|
| Hospital Charge Code |
4191
|
| 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
|
|
|
04764GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04764GZ
|
| Hospital Charge Code |
4192
|
| 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
|
|
