|
057C0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057C0DZ
|
| Hospital Charge Code |
4688
|
| 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
|
|
|
057C3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057C3D1
|
| Hospital Charge Code |
4689
|
| 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
|
|
|
057C3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057C3DZ
|
| Hospital Charge Code |
4690
|
| 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
|
|
|
057C4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057C4D1
|
| Hospital Charge Code |
4691
|
| 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
|
|
|
057C4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057C4DZ
|
| Hospital Charge Code |
4692
|
| 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
|
|
|
057D0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057D0D1
|
| Hospital Charge Code |
4693
|
| 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
|
|
|
057D0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057D0DZ
|
| Hospital Charge Code |
4694
|
| 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
|
|
|
057D3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057D3D1
|
| Hospital Charge Code |
4695
|
| 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
|
|
|
057D3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057D3DZ
|
| Hospital Charge Code |
4696
|
| 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
|
|
|
057D4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057D4D1
|
| Hospital Charge Code |
4697
|
| 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
|
|
|
057D4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057D4DZ
|
| Hospital Charge Code |
4698
|
| 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
|
|
|
057F0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057F0D1
|
| Hospital Charge Code |
4699
|
| 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
|
|
|
057F0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057F0DZ
|
| Hospital Charge Code |
4700
|
| 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
|
|
|
057F3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057F3D1
|
| Hospital Charge Code |
4701
|
| 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
|
|
|
057F3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057F3DZ
|
| Hospital Charge Code |
4702
|
| 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
|
|
|
057F4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057F4D1
|
| Hospital Charge Code |
4703
|
| 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
|
|
|
057F4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057F4DZ
|
| Hospital Charge Code |
4704
|
| 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
|
|
|
057G0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057G0DZ
|
| Hospital Charge Code |
4705
|
| 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
|
|
|
057G3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057G3DZ
|
| Hospital Charge Code |
4706
|
| 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
|
|
|
057G4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057G4DZ
|
| Hospital Charge Code |
4707
|
| 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
|
|
|
057H0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057H0DZ
|
| Hospital Charge Code |
4708
|
| 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
|
|
|
057H3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057H3DZ
|
| Hospital Charge Code |
4709
|
| 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
|
|
|
057H4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057H4DZ
|
| Hospital Charge Code |
4710
|
| 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
|
|
|
057L0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057L0DZ
|
| Hospital Charge Code |
4711
|
| 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
|
|
|
057L3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057L3DZ
|
| Hospital Charge Code |
4712
|
| 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
|
|
