|
0SG637Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG637Z
|
| Hospital Charge Code |
14888
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SG63JZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG63JZ
|
| Hospital Charge Code |
14889
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SG63KZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG63KZ
|
| Hospital Charge Code |
14890
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SG644Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG644Z
|
| Hospital Charge Code |
14891
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SG647Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG647Z
|
| Hospital Charge Code |
14892
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SG64JZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG64JZ
|
| Hospital Charge Code |
14893
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SG64KZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG64KZ
|
| Hospital Charge Code |
14894
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SG847Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0SG847Z
|
| Hospital Charge Code |
2625
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0SP908Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SP908Z
|
| Hospital Charge Code |
2626
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SP908Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SP908Z
|
| Hospital Charge Code |
14895
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SP909Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SP909Z
|
| Hospital Charge Code |
2627
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SP90BZ
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SP90BZ
|
| Hospital Charge Code |
2628
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SP90BZ
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SP90BZ
|
| Hospital Charge Code |
14896
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SP90JZ
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SP90JZ
|
| Hospital Charge Code |
2629
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SPB08Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SPB08Z
|
| Hospital Charge Code |
14897
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SPB08Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SPB08Z
|
| Hospital Charge Code |
2630
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SPB09Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SPB09Z
|
| Hospital Charge Code |
2631
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SPB0BZ
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SPB0BZ
|
| Hospital Charge Code |
14898
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SPB0BZ
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SPB0BZ
|
| Hospital Charge Code |
2632
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SPB0JZ
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SPB0JZ
|
| Hospital Charge Code |
2633
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SR901A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR901A
|
| Hospital Charge Code |
14910
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SR901A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR901A
|
| Hospital Charge Code |
2644
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SR901Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR901Z
|
| Hospital Charge Code |
14911
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SR9029
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR9029
|
| Hospital Charge Code |
14912
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SR9029
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR9029
|
| Hospital Charge Code |
2645
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
