|
0JH83PZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 0JH83PZ
|
| Hospital Charge Code |
2603
|
| 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
|
|
|
0JPT0FZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0JPT0FZ
|
| Hospital Charge Code |
2604
|
| 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
|
|
|
0JPT0MZ
|
Facility
|
IP
|
$30,092.00
|
|
|
Service Code
|
ICD 0JPT0MZ
|
| Hospital Charge Code |
2605
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2606
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2607
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2608
|
| 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
|
|
|
0JPT3FZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0JPT3FZ
|
| Hospital Charge Code |
2609
|
| 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
|
|
|
0JPT3MZ
|
Facility
|
IP
|
$30,092.00
|
|
|
Service Code
|
ICD 0JPT3MZ
|
| Hospital Charge Code |
2610
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2611
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2612
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2613
|
| 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
|
|
|
0JWT0PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JWT0PZ
|
| Hospital Charge Code |
2614
|
| 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
|
|
|
0JWT0PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JWT0PZ
|
| Hospital Charge Code |
2615
|
| 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
|
|
|
0JWT3PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JWT3PZ
|
| Hospital Charge Code |
2617
|
| 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
|
|
|
0JWT3PZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 0JWT3PZ
|
| Hospital Charge Code |
2616
|
| 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
|
|
|
0Q820ZZ
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 0Q820ZZ
|
| Hospital Charge Code |
2618
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0Q834ZZ
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 0Q834ZZ
|
| Hospital Charge Code |
2619
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0RG00AJ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 0RG00AJ
|
| Hospital Charge Code |
2620
|
| 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
|
|
|
0RG8471
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 0RG8471
|
| Hospital Charge Code |
2621
|
| 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
|
|
|
0RGA0AJ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 0RGA0AJ
|
| Hospital Charge Code |
2622
|
| 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
|
|
|
0RGA471
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 0RGA471
|
| Hospital Charge Code |
2623
|
| 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
|
|
|
0SG00AJ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 0SG00AJ
|
| Hospital Charge Code |
2624
|
| 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
|
|
|
0SG847Z
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 0SG847Z
|
| Hospital Charge Code |
2625
|
| 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
|
|
|
0SP908Z
|
Facility
|
IP
|
$9,112.00
|
|
|
Service Code
|
ICD 0SP908Z
|
| Hospital Charge Code |
2626
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
|
0SP909Z
|
Facility
|
IP
|
$9,112.00
|
|
|
Service Code
|
ICD 0SP909Z
|
| Hospital Charge Code |
2627
|
| Min. Negotiated Rate |
$9,112.00 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,112.00
|
|
