|
05780D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05780D1
|
| Hospital Charge Code |
4663
|
| 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
|
|
|
05780DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05780DZ
|
| Hospital Charge Code |
4664
|
| 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
|
|
|
05783D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05783D1
|
| Hospital Charge Code |
4665
|
| 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
|
|
|
05783DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05783DZ
|
| Hospital Charge Code |
4666
|
| 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
|
|
|
05784D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05784D1
|
| Hospital Charge Code |
4667
|
| 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
|
|
|
05784DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05784DZ
|
| Hospital Charge Code |
4668
|
| 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
|
|
|
05790D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05790D1
|
| Hospital Charge Code |
4669
|
| 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
|
|
|
05790DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05790DZ
|
| Hospital Charge Code |
4670
|
| 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
|
|
|
05793D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05793D1
|
| Hospital Charge Code |
4671
|
| 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
|
|
|
05793DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05793DZ
|
| Hospital Charge Code |
4672
|
| 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
|
|
|
05794D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05794D1
|
| Hospital Charge Code |
4673
|
| 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
|
|
|
05794DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 05794DZ
|
| Hospital Charge Code |
4674
|
| 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
|
|
|
057A0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057A0D1
|
| Hospital Charge Code |
4675
|
| 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
|
|
|
057A0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057A0DZ
|
| Hospital Charge Code |
4676
|
| 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
|
|
|
057A3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057A3D1
|
| Hospital Charge Code |
4677
|
| 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
|
|
|
057A3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057A3DZ
|
| Hospital Charge Code |
4678
|
| 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
|
|
|
057A4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057A4D1
|
| Hospital Charge Code |
4679
|
| 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
|
|
|
057A4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057A4DZ
|
| Hospital Charge Code |
4680
|
| 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
|
|
|
057B0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057B0D1
|
| Hospital Charge Code |
4681
|
| 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
|
|
|
057B0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057B0DZ
|
| Hospital Charge Code |
4682
|
| 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
|
|
|
057B3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057B3D1
|
| Hospital Charge Code |
4683
|
| 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
|
|
|
057B3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057B3DZ
|
| Hospital Charge Code |
4684
|
| 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
|
|
|
057B4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057B4D1
|
| Hospital Charge Code |
4685
|
| 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
|
|
|
057B4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057B4DZ
|
| Hospital Charge Code |
4686
|
| 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
|
|
|
057C0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057C0D1
|
| Hospital Charge Code |
4687
|
| 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
|
|
