|
0SR902A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR902A
|
| Hospital Charge Code |
14913
|
| 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
|
|
|
0SR902Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR902Z
|
| Hospital Charge Code |
14914
|
| 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
|
|
|
0SR9039
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR9039
|
| Hospital Charge Code |
14915
|
| 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
|
|
|
0SR9039
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR9039
|
| Hospital Charge Code |
5038
|
| 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
|
|
|
0SR903A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR903A
|
| Hospital Charge Code |
14916
|
| 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
|
|
|
0SR903Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR903Z
|
| Hospital Charge Code |
14917
|
| 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
|
|
|
0SR9049
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR9049
|
| Hospital Charge Code |
2646
|
| 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
|
|
|
0SR9049
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR9049
|
| Hospital Charge Code |
14918
|
| 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
|
|
|
0SR904A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR904A
|
| Hospital Charge Code |
14919
|
| 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
|
|
|
0SR904A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR904A
|
| Hospital Charge Code |
2647
|
| 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
|
|
|
0SR904Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR904Z
|
| Hospital Charge Code |
14920
|
| 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
|
|
|
0SR907Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR907Z
|
| Hospital Charge Code |
2648
|
| 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
|
|
|
0SR907Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SR907Z
|
| Hospital Charge Code |
14921
|
| 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
|
|
|
0SRB01A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB01A
|
| Hospital Charge Code |
2653
|
| 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
|
|
|
0SRB01A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB01A
|
| Hospital Charge Code |
14941
|
| 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
|
|
|
0SRB01Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB01Z
|
| Hospital Charge Code |
14942
|
| 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
|
|
|
0SRB029
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB029
|
| Hospital Charge Code |
14943
|
| 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
|
|
|
0SRB029
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB029
|
| Hospital Charge Code |
2654
|
| 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
|
|
|
0SRB02A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB02A
|
| Hospital Charge Code |
14944
|
| 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
|
|
|
0SRB02Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB02Z
|
| Hospital Charge Code |
14945
|
| 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
|
|
|
0SRB039
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB039
|
| Hospital Charge Code |
14946
|
| 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
|
|
|
0SRB039
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB039
|
| Hospital Charge Code |
5043
|
| 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
|
|
|
0SRB03A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB03A
|
| Hospital Charge Code |
14947
|
| 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
|
|
|
0SRB03Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB03Z
|
| Hospital Charge Code |
14948
|
| 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
|
|
|
0SRB049
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB049
|
| Hospital Charge Code |
14949
|
| 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
|
|
