|
06724DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06724DZ
|
| Hospital Charge Code |
4749
|
| 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
|
|
|
06730DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06730DZ
|
| Hospital Charge Code |
4750
|
| 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
|
|
|
06733DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06733DZ
|
| Hospital Charge Code |
4751
|
| 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
|
|
|
06734DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06734DZ
|
| Hospital Charge Code |
4752
|
| 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
|
|
|
06740DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06740DZ
|
| Hospital Charge Code |
4753
|
| 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
|
|
|
06743DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06743DZ
|
| Hospital Charge Code |
4754
|
| 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
|
|
|
06744DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06744DZ
|
| Hospital Charge Code |
4755
|
| 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
|
|
|
06750DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06750DZ
|
| Hospital Charge Code |
4756
|
| 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
|
|
|
06753DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06753DZ
|
| Hospital Charge Code |
4757
|
| 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
|
|
|
06754DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06754DZ
|
| Hospital Charge Code |
4758
|
| 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
|
|
|
06760DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06760DZ
|
| Hospital Charge Code |
4759
|
| 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
|
|
|
06763DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06763DZ
|
| Hospital Charge Code |
4760
|
| 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
|
|
|
06764DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06764DZ
|
| Hospital Charge Code |
4761
|
| 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
|
|
|
06770DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06770DZ
|
| Hospital Charge Code |
4762
|
| 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
|
|
|
06773DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06773DZ
|
| Hospital Charge Code |
4763
|
| 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
|
|
|
06774DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06774DZ
|
| Hospital Charge Code |
4764
|
| 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
|
|
|
06780DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06780DZ
|
| Hospital Charge Code |
4765
|
| 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
|
|
|
06783DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06783DZ
|
| Hospital Charge Code |
4766
|
| 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
|
|
|
06784DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06784DZ
|
| Hospital Charge Code |
4767
|
| 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
|
|
|
06790DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06790DZ
|
| Hospital Charge Code |
4768
|
| 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
|
|
|
06793DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06793DZ
|
| Hospital Charge Code |
4769
|
| 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
|
|
|
06794DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 06794DZ
|
| Hospital Charge Code |
4770
|
| 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
|
|
|
067B0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067B0DZ
|
| Hospital Charge Code |
4771
|
| 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
|
|
|
067B3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067B3DZ
|
| Hospital Charge Code |
4772
|
| 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
|
|
|
067B4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067B4DZ
|
| Hospital Charge Code |
4773
|
| 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
|
|
