|
05734DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05734DZ
|
| Hospital Charge Code |
4638
|
| 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
|
|
|
05740D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05740D1
|
| Hospital Charge Code |
4639
|
| 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
|
|
|
05740DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05740DZ
|
| Hospital Charge Code |
4640
|
| 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
|
|
|
05743D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05743D1
|
| Hospital Charge Code |
4641
|
| 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
|
|
|
05743DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05743DZ
|
| Hospital Charge Code |
4642
|
| 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
|
|
|
05744D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05744D1
|
| Hospital Charge Code |
4643
|
| 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
|
|
|
05744DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05744DZ
|
| Hospital Charge Code |
4644
|
| 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
|
|
|
05750D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05750D1
|
| Hospital Charge Code |
4645
|
| 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
|
|
|
05750DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05750DZ
|
| Hospital Charge Code |
4646
|
| 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
|
|
|
05753D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05753D1
|
| Hospital Charge Code |
4647
|
| 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
|
|
|
05753DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05753DZ
|
| Hospital Charge Code |
4648
|
| 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
|
|
|
05754D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05754D1
|
| Hospital Charge Code |
4649
|
| 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
|
|
|
05754DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05754DZ
|
| Hospital Charge Code |
4650
|
| 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
|
|
|
05760D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05760D1
|
| Hospital Charge Code |
4651
|
| 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
|
|
|
05760DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05760DZ
|
| Hospital Charge Code |
4652
|
| 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
|
|
|
05763D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05763D1
|
| Hospital Charge Code |
4653
|
| 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
|
|
|
05763DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05763DZ
|
| Hospital Charge Code |
4654
|
| 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
|
|
|
05764D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05764D1
|
| Hospital Charge Code |
4655
|
| 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
|
|
|
05764DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05764DZ
|
| Hospital Charge Code |
4656
|
| 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
|
|
|
05770D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05770D1
|
| Hospital Charge Code |
4657
|
| 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
|
|
|
05770DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05770DZ
|
| Hospital Charge Code |
4658
|
| 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
|
|
|
05773D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05773D1
|
| Hospital Charge Code |
4659
|
| 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
|
|
|
05773DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05773DZ
|
| Hospital Charge Code |
4660
|
| 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
|
|
|
05774D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05774D1
|
| Hospital Charge Code |
4661
|
| 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
|
|
|
05774DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05774DZ
|
| Hospital Charge Code |
4662
|
| 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
|
|
