|
0477441
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0477441
|
| Hospital Charge Code |
2057
|
| 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
|
|
|
047744Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047744Z
|
| Hospital Charge Code |
2058
|
| 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
|
|
|
047745Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047745Z
|
| Hospital Charge Code |
2059
|
| 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
|
|
|
047746Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047746Z
|
| Hospital Charge Code |
2060
|
| 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
|
|
|
047747Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047747Z
|
| Hospital Charge Code |
2061
|
| 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
|
|
|
04774D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04774D1
|
| Hospital Charge Code |
4205
|
| 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
|
|
|
04774D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04774D6
|
| Hospital Charge Code |
4206
|
| 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
|
|
|
04774DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04774DZ
|
| Hospital Charge Code |
4207
|
| 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
|
|
|
04774EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04774EZ
|
| Hospital Charge Code |
4208
|
| 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
|
|
|
04774FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04774FZ
|
| Hospital Charge Code |
4209
|
| 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
|
|
|
04774GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04774GZ
|
| Hospital Charge Code |
4210
|
| 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
|
|
|
0478041
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0478041
|
| Hospital Charge Code |
2062
|
| 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
|
|
|
047804Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047804Z
|
| Hospital Charge Code |
2063
|
| 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
|
|
|
047805Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047805Z
|
| Hospital Charge Code |
2064
|
| 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
|
|
|
047806Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047806Z
|
| Hospital Charge Code |
2065
|
| 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
|
|
|
047807Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047807Z
|
| Hospital Charge Code |
2066
|
| 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
|
|
|
04780D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04780D1
|
| Hospital Charge Code |
4211
|
| 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
|
|
|
04780D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04780D6
|
| Hospital Charge Code |
4212
|
| 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
|
|
|
04780DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04780DZ
|
| Hospital Charge Code |
4213
|
| 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
|
|
|
04780EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04780EZ
|
| Hospital Charge Code |
4214
|
| 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
|
|
|
04780FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04780FZ
|
| Hospital Charge Code |
4215
|
| 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
|
|
|
04780GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 04780GZ
|
| Hospital Charge Code |
4216
|
| 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
|
|
|
0478341
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0478341
|
| Hospital Charge Code |
2067
|
| 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
|
|
|
047834Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047834Z
|
| Hospital Charge Code |
2068
|
| 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
|
|
|
047835Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 047835Z
|
| Hospital Charge Code |
2069
|
| 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
|
|
