|
0JH60AZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2540
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0JH60BZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2541
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH60CZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2542
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH60DZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2543
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH60EZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2544
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH60FZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2545
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0JH60MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2546
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH60PZ
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2547
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH634Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2548
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH635Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2549
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH636Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2550
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH637Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2551
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH638Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2553
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
0JH638Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2552
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
0JH639Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2554
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
0JH639Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2555
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
0JH63AZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2556
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0JH63BZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2557
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH63CZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2558
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH63DZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2559
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH63EZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2560
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH63FZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2561
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0JH63MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2562
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0JH63PZ
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2563
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH70BZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2564
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
