|
04743GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04743GZ
|
| Hospital Charge Code |
4150
|
| 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
|
|
|
0474441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0474441
|
| Hospital Charge Code |
2012
|
| 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
|
|
|
047444Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047444Z
|
| Hospital Charge Code |
2013
|
| 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
|
|
|
047445Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047445Z
|
| Hospital Charge Code |
2014
|
| 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
|
|
|
047446Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047446Z
|
| Hospital Charge Code |
2015
|
| 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
|
|
|
047447Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047447Z
|
| Hospital Charge Code |
2016
|
| 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
|
|
|
04744D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04744D1
|
| Hospital Charge Code |
4151
|
| 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
|
|
|
04744D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04744D6
|
| Hospital Charge Code |
4152
|
| 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
|
|
|
04744DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04744DZ
|
| Hospital Charge Code |
4153
|
| 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
|
|
|
04744EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04744EZ
|
| Hospital Charge Code |
4154
|
| 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
|
|
|
04744FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04744FZ
|
| Hospital Charge Code |
4155
|
| 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
|
|
|
04744GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04744GZ
|
| Hospital Charge Code |
4156
|
| 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
|
|
|
0475041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0475041
|
| Hospital Charge Code |
2017
|
| 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
|
|
|
047504Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047504Z
|
| Hospital Charge Code |
2018
|
| 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
|
|
|
047505Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047505Z
|
| Hospital Charge Code |
2019
|
| 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
|
|
|
047506Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047506Z
|
| Hospital Charge Code |
2020
|
| 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
|
|
|
047507Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047507Z
|
| Hospital Charge Code |
2021
|
| 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
|
|
|
04750D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04750D1
|
| Hospital Charge Code |
4157
|
| 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
|
|
|
04750D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04750D6
|
| Hospital Charge Code |
4158
|
| 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
|
|
|
04750DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04750DZ
|
| Hospital Charge Code |
4159
|
| 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
|
|
|
04750EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04750EZ
|
| Hospital Charge Code |
4160
|
| 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
|
|
|
04750FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04750FZ
|
| Hospital Charge Code |
4161
|
| 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
|
|
|
04750GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04750GZ
|
| Hospital Charge Code |
4162
|
| 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
|
|
|
0475341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0475341
|
| Hospital Charge Code |
2022
|
| 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
|
|
|
047534Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047534Z
|
| Hospital Charge Code |
2023
|
| 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
|
|
