|
0SPD0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SPD0JZ
|
| Hospital Charge Code |
2641
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SPD48Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SPD48Z
|
| Hospital Charge Code |
2642
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SPD48Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SPD48Z
|
| Hospital Charge Code |
14907
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SPD4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SPD4JZ
|
| Hospital Charge Code |
2643
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SPD4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SPD4JZ
|
| Hospital Charge Code |
14908
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0JA
|
| Hospital Charge Code |
2661
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0JA
|
| Hospital Charge Code |
14959
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0JZ
|
| Hospital Charge Code |
14960
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0KZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0KZ
|
| Hospital Charge Code |
14961
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0L9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0L9
|
| Hospital Charge Code |
2662
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0L9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0L9
|
| Hospital Charge Code |
14962
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0LA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0LA
|
| Hospital Charge Code |
2663
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0LA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0LA
|
| Hospital Charge Code |
14963
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0LZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0LZ
|
| Hospital Charge Code |
2664
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRC0LZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRC0LZ
|
| Hospital Charge Code |
14964
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD07Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD07Z
|
| Hospital Charge Code |
14965
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD07Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD07Z
|
| Hospital Charge Code |
2665
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD0L9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD0L9
|
| Hospital Charge Code |
14970
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD0L9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD0L9
|
| Hospital Charge Code |
2668
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD0LA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD0LA
|
| Hospital Charge Code |
2669
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD0LA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD0LA
|
| Hospital Charge Code |
14971
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD0LZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD0LZ
|
| Hospital Charge Code |
2670
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRD0LZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRD0LZ
|
| Hospital Charge Code |
14972
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRT0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRT0JA
|
| Hospital Charge Code |
2673
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0SRT0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRT0JA
|
| Hospital Charge Code |
15045
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
