|
0JH807Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH807Z
|
| Hospital Charge Code |
2581
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH808Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH808Z
|
| Hospital Charge Code |
2582
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH808Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH808Z
|
| Hospital Charge Code |
2583
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH808Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH808Z
|
| Hospital Charge Code |
13937
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH809Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH809Z
|
| Hospital Charge Code |
2585
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH809Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH809Z
|
| Hospital Charge Code |
13938
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH809Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH809Z
|
| Hospital Charge Code |
2584
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH80AZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0JH80AZ
|
| Hospital Charge Code |
2586
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0JH80BZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH80BZ
|
| Hospital Charge Code |
2587
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0JH80CZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH80CZ
|
| Hospital Charge Code |
5008
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0JH80DZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH80DZ
|
| Hospital Charge Code |
5009
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0JH80EZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH80EZ
|
| Hospital Charge Code |
2588
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0JH80MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH80MZ
|
| Hospital Charge Code |
2589
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0JH80PZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH80PZ
|
| Hospital Charge Code |
2590
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH834Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH834Z
|
| Hospital Charge Code |
2591
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH835Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH835Z
|
| Hospital Charge Code |
2592
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH836Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH836Z
|
| Hospital Charge Code |
2593
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH837Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH837Z
|
| Hospital Charge Code |
2594
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH838Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH838Z
|
| Hospital Charge Code |
2595
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH838Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH838Z
|
| Hospital Charge Code |
2596
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH838Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH838Z
|
| Hospital Charge Code |
13939
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH839Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH839Z
|
| Hospital Charge Code |
2597
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH839Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH839Z
|
| Hospital Charge Code |
2598
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH839Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH839Z
|
| Hospital Charge Code |
13940
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH83AZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0JH83AZ
|
| Hospital Charge Code |
2599
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
