|
DV11B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DV11B6Z
|
| Hospital Charge Code |
5563
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DV11BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DV11BB1
|
| Hospital Charge Code |
5564
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW10BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW10BB1
|
| Hospital Charge Code |
5565
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW10BBZ
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW10BBZ
|
| Hospital Charge Code |
5566
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW11B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW11B6Z
|
| Hospital Charge Code |
5567
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW11BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW11BB1
|
| Hospital Charge Code |
5568
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW12B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW12B6Z
|
| Hospital Charge Code |
5569
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW12BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW12BB1
|
| Hospital Charge Code |
5570
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW13B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW13B6Z
|
| Hospital Charge Code |
5571
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW13BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW13BB1
|
| Hospital Charge Code |
5572
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW16B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW16B6Z
|
| Hospital Charge Code |
5573
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW16BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW16BB1
|
| Hospital Charge Code |
5574
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1KBB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1KBB1
|
| Hospital Charge Code |
5575
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1KBBZ
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1KBBZ
|
| Hospital Charge Code |
5576
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1LBB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1LBB1
|
| Hospital Charge Code |
5577
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1LBBZ
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1LBBZ
|
| Hospital Charge Code |
5578
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1PBB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1PBB1
|
| Hospital Charge Code |
5579
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1PBBZ
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1PBBZ
|
| Hospital Charge Code |
5580
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1QBB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1QBB1
|
| Hospital Charge Code |
5581
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1QBBZ
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1QBBZ
|
| Hospital Charge Code |
5582
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1RBB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1RBB1
|
| Hospital Charge Code |
5583
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1RBBZ
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1RBBZ
|
| Hospital Charge Code |
5584
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1XBB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1XBB1
|
| Hospital Charge Code |
5585
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1XBBZ
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1XBBZ
|
| Hospital Charge Code |
5586
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
DW1YBB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD DW1YBB1
|
| Hospital Charge Code |
5587
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
