|
04783D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04783D6
|
| Hospital Charge Code |
4218
|
| 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
|
|
|
04783DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04783DZ
|
| Hospital Charge Code |
4219
|
| 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
|
|
|
04783EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04783EZ
|
| Hospital Charge Code |
4220
|
| 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
|
|
|
04783FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04783FZ
|
| Hospital Charge Code |
4221
|
| 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
|
|
|
04783GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04783GZ
|
| Hospital Charge Code |
4222
|
| 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
|
|
|
0478441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0478441
|
| Hospital Charge Code |
2072
|
| 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
|
|
|
047844Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047844Z
|
| Hospital Charge Code |
2073
|
| 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
|
|
|
047845Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047845Z
|
| Hospital Charge Code |
2074
|
| 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
|
|
|
047846Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047846Z
|
| Hospital Charge Code |
2075
|
| 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
|
|
|
047847Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047847Z
|
| Hospital Charge Code |
2076
|
| 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
|
|
|
04784D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04784D1
|
| Hospital Charge Code |
4223
|
| 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
|
|
|
04784D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04784D6
|
| Hospital Charge Code |
4224
|
| 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
|
|
|
04784DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04784DZ
|
| Hospital Charge Code |
4225
|
| 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
|
|
|
04784EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04784EZ
|
| Hospital Charge Code |
4226
|
| 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
|
|
|
04784FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04784FZ
|
| Hospital Charge Code |
4227
|
| 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
|
|
|
04784GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04784GZ
|
| Hospital Charge Code |
4228
|
| 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
|
|
|
0479041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0479041
|
| Hospital Charge Code |
2077
|
| 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
|
|
|
047904Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047904Z
|
| Hospital Charge Code |
2078
|
| 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
|
|
|
047905Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047905Z
|
| Hospital Charge Code |
2079
|
| 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
|
|
|
047906Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047906Z
|
| Hospital Charge Code |
2080
|
| 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
|
|
|
047907Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047907Z
|
| Hospital Charge Code |
2081
|
| 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
|
|
|
04790D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04790D1
|
| Hospital Charge Code |
4229
|
| 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
|
|
|
04790D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04790D6
|
| Hospital Charge Code |
4230
|
| 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
|
|
|
04790DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04790DZ
|
| Hospital Charge Code |
4231
|
| 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
|
|
|
04790EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04790EZ
|
| Hospital Charge Code |
4232
|
| 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
|
|
