|
D713BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D713BB1
|
| Hospital Charge Code |
5461
|
| 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
|
|
|
D714B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D714B6Z
|
| Hospital Charge Code |
5462
|
| 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
|
|
|
D714BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D714BB1
|
| Hospital Charge Code |
5463
|
| 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
|
|
|
D715B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D715B6Z
|
| Hospital Charge Code |
5464
|
| 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
|
|
|
D715BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D715BB1
|
| Hospital Charge Code |
5465
|
| 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
|
|
|
D716B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D716B6Z
|
| Hospital Charge Code |
5466
|
| 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
|
|
|
D716BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D716BB1
|
| Hospital Charge Code |
5467
|
| 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
|
|
|
D717B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D717B6Z
|
| Hospital Charge Code |
5468
|
| 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
|
|
|
D717BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D717BB1
|
| Hospital Charge Code |
5469
|
| 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
|
|
|
D718B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D718B6Z
|
| Hospital Charge Code |
5470
|
| 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
|
|
|
D718BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D718BB1
|
| Hospital Charge Code |
5471
|
| 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
|
|
|
D810B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D810B6Z
|
| Hospital Charge Code |
5472
|
| 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
|
|
|
D810BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D810BB1
|
| Hospital Charge Code |
5473
|
| 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
|
|
|
D910B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D910B6Z
|
| Hospital Charge Code |
5474
|
| 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
|
|
|
D910BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D910BB1
|
| Hospital Charge Code |
5475
|
| 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
|
|
|
D911B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D911B6Z
|
| Hospital Charge Code |
5476
|
| 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
|
|
|
D911BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D911BB1
|
| Hospital Charge Code |
5477
|
| 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
|
|
|
D913B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D913B6Z
|
| Hospital Charge Code |
5478
|
| 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
|
|
|
D913BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D913BB1
|
| Hospital Charge Code |
5479
|
| 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
|
|
|
D914B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D914B6Z
|
| Hospital Charge Code |
5480
|
| 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
|
|
|
D914BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D914BB1
|
| Hospital Charge Code |
5481
|
| 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
|
|
|
D915B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D915B6Z
|
| Hospital Charge Code |
5482
|
| 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
|
|
|
D915BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D915BB1
|
| Hospital Charge Code |
5483
|
| 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
|
|
|
D916B6Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D916B6Z
|
| Hospital Charge Code |
5484
|
| 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
|
|
|
D916BB1
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD D916BB1
|
| Hospital Charge Code |
5485
|
| 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
|
|
