|
04790FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04790FZ
|
| Hospital Charge Code |
4233
|
| 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
|
|
|
04790GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04790GZ
|
| Hospital Charge Code |
4234
|
| 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
|
|
|
0479341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0479341
|
| Hospital Charge Code |
2082
|
| 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
|
|
|
047934Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047934Z
|
| Hospital Charge Code |
2083
|
| 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
|
|
|
047935Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047935Z
|
| Hospital Charge Code |
2084
|
| 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
|
|
|
047936Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047936Z
|
| Hospital Charge Code |
2085
|
| 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
|
|
|
047937Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047937Z
|
| Hospital Charge Code |
2086
|
| 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
|
|
|
04793D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04793D1
|
| Hospital Charge Code |
4235
|
| 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
|
|
|
04793D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04793D6
|
| Hospital Charge Code |
4236
|
| 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
|
|
|
04793DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04793DZ
|
| Hospital Charge Code |
4237
|
| 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
|
|
|
04793EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04793EZ
|
| Hospital Charge Code |
4238
|
| 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
|
|
|
04793FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04793FZ
|
| Hospital Charge Code |
4239
|
| 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
|
|
|
04793GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04793GZ
|
| Hospital Charge Code |
4240
|
| 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
|
|
|
0479441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0479441
|
| Hospital Charge Code |
2087
|
| 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
|
|
|
047944Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047944Z
|
| Hospital Charge Code |
2088
|
| 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
|
|
|
047945Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047945Z
|
| Hospital Charge Code |
2089
|
| 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
|
|
|
047946Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047946Z
|
| Hospital Charge Code |
2090
|
| 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
|
|
|
047947Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047947Z
|
| Hospital Charge Code |
2091
|
| 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
|
|
|
04794D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04794D1
|
| Hospital Charge Code |
4241
|
| 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
|
|
|
04794D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04794D6
|
| Hospital Charge Code |
4242
|
| 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
|
|
|
04794DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04794DZ
|
| Hospital Charge Code |
4243
|
| 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
|
|
|
04794EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04794EZ
|
| Hospital Charge Code |
4244
|
| 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
|
|
|
04794FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04794FZ
|
| Hospital Charge Code |
4245
|
| 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
|
|
|
04794GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 04794GZ
|
| Hospital Charge Code |
4246
|
| 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
|
|
|
047A041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047A041
|
| Hospital Charge Code |
2092
|
| 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
|
|
