|
0477041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0477041
|
| Hospital Charge Code |
2047
|
| 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
|
|
|
047704Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047704Z
|
| Hospital Charge Code |
2048
|
| 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
|
|
|
047705Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047705Z
|
| Hospital Charge Code |
2049
|
| 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
|
|
|
047706Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047706Z
|
| Hospital Charge Code |
2050
|
| 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
|
|
|
047707Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047707Z
|
| Hospital Charge Code |
2051
|
| 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
|
|
|
04770D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04770D1
|
| Hospital Charge Code |
4193
|
| 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
|
|
|
04770D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04770D6
|
| Hospital Charge Code |
4194
|
| 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
|
|
|
04770DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04770DZ
|
| Hospital Charge Code |
4195
|
| 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
|
|
|
04770EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04770EZ
|
| Hospital Charge Code |
4196
|
| 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
|
|
|
04770FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04770FZ
|
| Hospital Charge Code |
4197
|
| 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
|
|
|
04770GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04770GZ
|
| Hospital Charge Code |
4198
|
| 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
|
|
|
0477341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0477341
|
| Hospital Charge Code |
2052
|
| 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
|
|
|
047734Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047734Z
|
| Hospital Charge Code |
2053
|
| 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
|
|
|
047735Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047735Z
|
| Hospital Charge Code |
2054
|
| 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
|
|
|
047736Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047736Z
|
| Hospital Charge Code |
2055
|
| 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
|
|
|
047737Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047737Z
|
| Hospital Charge Code |
2056
|
| 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
|
|
|
04773D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04773D1
|
| Hospital Charge Code |
4199
|
| 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
|
|
|
04773D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04773D6
|
| Hospital Charge Code |
4200
|
| 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
|
|
|
04773DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04773DZ
|
| Hospital Charge Code |
4201
|
| 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
|
|
|
04773EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04773EZ
|
| Hospital Charge Code |
4202
|
| 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
|
|
|
04773FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04773FZ
|
| Hospital Charge Code |
4203
|
| 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
|
|
|
04773GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04773GZ
|
| Hospital Charge Code |
4204
|
| 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
|
|
|
0477441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0477441
|
| Hospital Charge Code |
2057
|
| 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
|
|
|
047744Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047744Z
|
| Hospital Charge Code |
2058
|
| 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
|
|
|
047745Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047745Z
|
| Hospital Charge Code |
2059
|
| 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
|
|
