|
057L4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057L4DZ
|
| Hospital Charge Code |
4713
|
| 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
|
|
|
057M0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057M0DZ
|
| Hospital Charge Code |
4714
|
| 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
|
|
|
057M3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057M3DZ
|
| Hospital Charge Code |
4715
|
| 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
|
|
|
057M4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057M4DZ
|
| Hospital Charge Code |
4716
|
| 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
|
|
|
057N0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057N0DZ
|
| Hospital Charge Code |
4717
|
| 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
|
|
|
057N3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057N3DZ
|
| Hospital Charge Code |
4718
|
| 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
|
|
|
057N4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057N4DZ
|
| Hospital Charge Code |
4719
|
| 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
|
|
|
057P0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057P0DZ
|
| Hospital Charge Code |
4720
|
| 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
|
|
|
057P3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057P3DZ
|
| Hospital Charge Code |
4721
|
| 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
|
|
|
057P4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057P4DZ
|
| Hospital Charge Code |
4722
|
| 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
|
|
|
057Q0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057Q0DZ
|
| Hospital Charge Code |
4723
|
| 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
|
|
|
057Q3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057Q3DZ
|
| Hospital Charge Code |
4724
|
| 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
|
|
|
057Q4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057Q4DZ
|
| Hospital Charge Code |
4725
|
| 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
|
|
|
057R0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057R0DZ
|
| Hospital Charge Code |
4726
|
| 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
|
|
|
057R3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057R3DZ
|
| Hospital Charge Code |
4727
|
| 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
|
|
|
057R4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057R4DZ
|
| Hospital Charge Code |
4728
|
| 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
|
|
|
057S0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057S0DZ
|
| Hospital Charge Code |
4729
|
| 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
|
|
|
057S3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057S3DZ
|
| Hospital Charge Code |
4730
|
| 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
|
|
|
057S4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057S4DZ
|
| Hospital Charge Code |
4731
|
| 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
|
|
|
057T0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057T0DZ
|
| Hospital Charge Code |
4732
|
| 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
|
|
|
057T3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057T3DZ
|
| Hospital Charge Code |
4733
|
| 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
|
|
|
057T4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057T4DZ
|
| Hospital Charge Code |
4734
|
| 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
|
|
|
057V0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057V0DZ
|
| Hospital Charge Code |
4735
|
| 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
|
|
|
057V3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057V3DZ
|
| Hospital Charge Code |
4736
|
| 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
|
|
|
057V4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 057V4DZ
|
| Hospital Charge Code |
4737
|
| 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
|
|
