|
04713FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04713FZ
|
| Hospital Charge Code |
4095
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04713GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04713GZ
|
| Hospital Charge Code |
4096
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
0471441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0471441
|
| Hospital Charge Code |
1967
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047144Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047144Z
|
| Hospital Charge Code |
1968
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047145Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047145Z
|
| Hospital Charge Code |
1969
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047146Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047146Z
|
| Hospital Charge Code |
1970
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047147Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047147Z
|
| Hospital Charge Code |
1971
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
04714D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04714D1
|
| Hospital Charge Code |
4097
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04714D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04714D6
|
| Hospital Charge Code |
4098
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04714DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04714DZ
|
| Hospital Charge Code |
4099
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04714EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04714EZ
|
| Hospital Charge Code |
4100
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04714FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04714FZ
|
| Hospital Charge Code |
4101
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04714GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04714GZ
|
| Hospital Charge Code |
4102
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
0472041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0472041
|
| Hospital Charge Code |
1972
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047204Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047204Z
|
| Hospital Charge Code |
1973
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047205Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047205Z
|
| Hospital Charge Code |
1974
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047206Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047206Z
|
| Hospital Charge Code |
1975
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
047207Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047207Z
|
| Hospital Charge Code |
1976
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
04720D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04720D1
|
| Hospital Charge Code |
4103
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04720D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04720D6
|
| Hospital Charge Code |
4104
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04720DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04720DZ
|
| Hospital Charge Code |
4105
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04720EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04720EZ
|
| Hospital Charge Code |
4106
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04720FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04720FZ
|
| Hospital Charge Code |
4107
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
04720GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04720GZ
|
| Hospital Charge Code |
4108
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
0472341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0472341
|
| Hospital Charge Code |
1977
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
