|
0SRT0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRT0JZ
|
| Hospital Charge Code |
15046
|
| 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
|
|
|
0SRT0KZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRT0KZ
|
| Hospital Charge Code |
15047
|
| 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
|
|
|
0SRU07Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRU07Z
|
| Hospital Charge Code |
15048
|
| 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
|
|
|
0SRU0J9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRU0J9
|
| Hospital Charge Code |
15049
|
| 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
|
|
|
0SRU0J9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRU0J9
|
| Hospital Charge Code |
5062
|
| 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
|
|
|
0SRU0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRU0JA
|
| Hospital Charge Code |
5063
|
| 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
|
|
|
0SRU0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRU0JA
|
| Hospital Charge Code |
15050
|
| 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
|
|
|
0SRU0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRU0JZ
|
| Hospital Charge Code |
15051
|
| 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
|
|
|
0SRU0KZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRU0KZ
|
| Hospital Charge Code |
15052
|
| 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
|
|
|
0SRV07Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRV07Z
|
| Hospital Charge Code |
15053
|
| 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
|
|
|
0SRV0J9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRV0J9
|
| Hospital Charge Code |
5064
|
| 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
|
|
|
0SRV0J9
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRV0J9
|
| Hospital Charge Code |
15054
|
| 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
|
|
|
0SRV0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRV0JA
|
| Hospital Charge Code |
5065
|
| 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
|
|
|
0SRV0JA
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRV0JA
|
| Hospital Charge Code |
15055
|
| 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
|
|
|
0SRV0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRV0JZ
|
| Hospital Charge Code |
15056
|
| 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
|
|
|
0SRV0KZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRV0KZ
|
| Hospital Charge Code |
15057
|
| 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
|
|
|
0SRW07Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRW07Z
|
| Hospital Charge Code |
15058
|
| 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
|
|
|
0SRW07Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SRW07Z
|
| Hospital Charge Code |
2674
|
| 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
|
|
|
0SUC09C
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SUC09C
|
| Hospital Charge Code |
15068
|
| 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
|
|
|
0SUC09C
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SUC09C
|
| Hospital Charge Code |
5071
|
| 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
|
|
|
0SUD09C
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SUD09C
|
| Hospital Charge Code |
5072
|
| 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
|
|
|
0SUD09C
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SUD09C
|
| Hospital Charge Code |
15069
|
| 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
|
|
|
0SUV09Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SUV09Z
|
| Hospital Charge Code |
15073
|
| 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
|
|
|
0SUV09Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SUV09Z
|
| Hospital Charge Code |
5076
|
| 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
|
|
|
0SUW09Z
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0SUW09Z
|
| Hospital Charge Code |
15074
|
| 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
|
|
