|
067C0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067C0DZ
|
| Hospital Charge Code |
4774
|
| 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
|
|
|
067C3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067C3DZ
|
| Hospital Charge Code |
4775
|
| 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
|
|
|
067C4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067C4DZ
|
| Hospital Charge Code |
4776
|
| 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
|
|
|
067D0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067D0DZ
|
| Hospital Charge Code |
4777
|
| 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
|
|
|
067D3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067D3DZ
|
| Hospital Charge Code |
4778
|
| 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
|
|
|
067D4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067D4DZ
|
| Hospital Charge Code |
4779
|
| 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
|
|
|
067F0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067F0DZ
|
| Hospital Charge Code |
4780
|
| 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
|
|
|
067F3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067F3DZ
|
| Hospital Charge Code |
4781
|
| 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
|
|
|
067F4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067F4DZ
|
| Hospital Charge Code |
4782
|
| 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
|
|
|
067G0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067G0DZ
|
| Hospital Charge Code |
4783
|
| 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
|
|
|
067G3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067G3DZ
|
| Hospital Charge Code |
4784
|
| 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
|
|
|
067G4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067G4DZ
|
| Hospital Charge Code |
4785
|
| 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
|
|
|
067H0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067H0DZ
|
| Hospital Charge Code |
4786
|
| 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
|
|
|
067H3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067H3DZ
|
| Hospital Charge Code |
4787
|
| 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
|
|
|
067H4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067H4DZ
|
| Hospital Charge Code |
4788
|
| 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
|
|
|
067J0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067J0DZ
|
| Hospital Charge Code |
4789
|
| 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
|
|
|
067J3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067J3DZ
|
| Hospital Charge Code |
4790
|
| 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
|
|
|
067J4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067J4DZ
|
| Hospital Charge Code |
4791
|
| 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
|
|
|
067M0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067M0DZ
|
| Hospital Charge Code |
4792
|
| 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
|
|
|
067M3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067M3DZ
|
| Hospital Charge Code |
4793
|
| 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
|
|
|
067M4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067M4DZ
|
| Hospital Charge Code |
4794
|
| 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
|
|
|
067N0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067N0DZ
|
| Hospital Charge Code |
4795
|
| 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
|
|
|
067N3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067N3DZ
|
| Hospital Charge Code |
4796
|
| 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
|
|
|
067N4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067N4DZ
|
| Hospital Charge Code |
4797
|
| 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
|
|
|
067P0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067P0DZ
|
| Hospital Charge Code |
4798
|
| 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
|
|
