|
067P3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067P3DZ
|
| Hospital Charge Code |
4799
|
| 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
|
|
|
067P4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067P4DZ
|
| Hospital Charge Code |
4800
|
| 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
|
|
|
067Q0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067Q0DZ
|
| Hospital Charge Code |
4801
|
| 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
|
|
|
067Q3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067Q3DZ
|
| Hospital Charge Code |
4802
|
| 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
|
|
|
067Q4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067Q4DZ
|
| Hospital Charge Code |
4803
|
| 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
|
|
|
067R0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067R0DZ
|
| Hospital Charge Code |
4804
|
| 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
|
|
|
067R3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067R3DZ
|
| Hospital Charge Code |
4805
|
| 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
|
|
|
067R4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067R4DZ
|
| Hospital Charge Code |
4806
|
| 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
|
|
|
067S0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067S0DZ
|
| Hospital Charge Code |
4807
|
| 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
|
|
|
067S3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067S3DZ
|
| Hospital Charge Code |
4808
|
| 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
|
|
|
067S4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067S4DZ
|
| Hospital Charge Code |
4809
|
| 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
|
|
|
067T0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067T0DZ
|
| Hospital Charge Code |
4810
|
| 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
|
|
|
067T3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067T3DZ
|
| Hospital Charge Code |
4811
|
| 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
|
|
|
067T4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067T4DZ
|
| Hospital Charge Code |
4812
|
| 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
|
|
|
067V0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067V0DZ
|
| Hospital Charge Code |
4813
|
| 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
|
|
|
067V3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067V3DZ
|
| Hospital Charge Code |
4814
|
| 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
|
|
|
067V4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067V4DZ
|
| Hospital Charge Code |
4815
|
| 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
|
|
|
067Y0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067Y0DZ
|
| Hospital Charge Code |
4816
|
| 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
|
|
|
067Y3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067Y3DZ
|
| Hospital Charge Code |
4817
|
| 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
|
|
|
067Y4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 067Y4DZ
|
| Hospital Charge Code |
4818
|
| 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
|
|
|
07HK01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 07HK01Z
|
| Hospital Charge Code |
4819
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
07HK31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 07HK31Z
|
| Hospital Charge Code |
4820
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
07HK41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 07HK41Z
|
| Hospital Charge Code |
4821
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
07HL01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 07HL01Z
|
| Hospital Charge Code |
4822
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
07HL31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 07HL31Z
|
| Hospital Charge Code |
4823
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
