|
0SP90BZ
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2628
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SP90JZ
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2629
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SPB08Z
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2630
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SPB09Z
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2631
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SPB0BZ
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2632
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SPB0JZ
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2633
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SR901A
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2644
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SR9029
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2645
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SR9039
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
5038
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SR9049
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2646
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SR904A
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2647
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SR907Z
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2648
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SRB01A
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2653
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SRB029
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2654
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SRB039
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
5043
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SRB049
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2655
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SRB04A
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2656
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SRB07Z
|
Facility
|
IP
|
$9,112.00
|
|
| Hospital Charge Code |
2657
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0TQB0ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2675
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0TQB8ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2676
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0TQD7ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2677
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0UQ90ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2680
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0UQ98ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2681
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0UQC0ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2682
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0UQC8ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2683
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
