|
0SPD4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPD4JZ
|
| Hospital Charge Code |
2643
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRC0JA
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRC0JA
|
| Hospital Charge Code |
2661
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRC0L9
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRC0L9
|
| Hospital Charge Code |
2662
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRC0LA
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRC0LA
|
| Hospital Charge Code |
2663
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRC0LZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRC0LZ
|
| Hospital Charge Code |
2664
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRD07Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRD07Z
|
| Hospital Charge Code |
2665
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRD0L9
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRD0L9
|
| Hospital Charge Code |
2668
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRD0LA
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRD0LA
|
| Hospital Charge Code |
2669
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRD0LZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRD0LZ
|
| Hospital Charge Code |
2670
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRT0JA
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRT0JA
|
| Hospital Charge Code |
2673
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRU0J9
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRU0J9
|
| Hospital Charge Code |
5062
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRU0JA
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRU0JA
|
| Hospital Charge Code |
5063
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRV0J9
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRV0J9
|
| Hospital Charge Code |
5064
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRV0JA
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRV0JA
|
| Hospital Charge Code |
5065
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SRW07Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SRW07Z
|
| Hospital Charge Code |
2674
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SUC09C
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SUC09C
|
| Hospital Charge Code |
5071
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SUD09C
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SUD09C
|
| Hospital Charge Code |
5072
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SUV09Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SUV09Z
|
| Hospital Charge Code |
5076
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SUW09Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SUW09Z
|
| Hospital Charge Code |
5077
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SWC0JC
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWC0JC
|
| Hospital Charge Code |
5087
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SWC0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWC0JZ
|
| Hospital Charge Code |
5088
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SWC3JC
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWC3JC
|
| Hospital Charge Code |
5089
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SWC3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWC3JZ
|
| Hospital Charge Code |
5090
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SWC4JC
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWC4JC
|
| Hospital Charge Code |
5091
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SWC4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWC4JZ
|
| Hospital Charge Code |
5092
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
