|
0JH83BZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH83BZ
|
| Hospital Charge Code |
2600
|
| 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
|
|
|
0JH83EZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH83EZ
|
| Hospital Charge Code |
2601
|
| 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
|
|
|
0JH83MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH83MZ
|
| Hospital Charge Code |
2602
|
| 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
|
|
|
0JH83PZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH83PZ
|
| Hospital Charge Code |
2603
|
| 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
|
|
|
0JPT0FZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0JPT0FZ
|
| Hospital Charge Code |
2604
|
| 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
|
|
|
0JPT0MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JPT0MZ
|
| Hospital Charge Code |
2605
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2607
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2606
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2608
|
| 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
|
|
|
0JPT3FZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0JPT3FZ
|
| Hospital Charge Code |
2609
|
| 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
|
|
|
0JPT3MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JPT3MZ
|
| Hospital Charge Code |
2610
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2612
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2611
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2613
|
| 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
|
|
|
0JWT0PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JWT0PZ
|
| Hospital Charge Code |
2615
|
| 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
|
|
|
0JWT0PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JWT0PZ
|
| Hospital Charge Code |
2614
|
| 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
|
|
|
0JWT3PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JWT3PZ
|
| Hospital Charge Code |
2616
|
| 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
|
|
|
0JWT3PZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JWT3PZ
|
| Hospital Charge Code |
2617
|
| 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
|
|
|
0Q820ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0Q820ZZ
|
| Hospital Charge Code |
2618
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
0Q834ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0Q834ZZ
|
| Hospital Charge Code |
2619
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
0RG00AJ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0RG00AJ
|
| Hospital Charge Code |
2620
|
| 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
|
|
|
0RG00AJ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0RG00AJ
|
| Hospital Charge Code |
14443
|
| 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
|
|
|
0RG00J0
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0RG00J0
|
| Hospital Charge Code |
14444
|
| 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
|
|
|
0RG00J1
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0RG00J1
|
| Hospital Charge Code |
14445
|
| 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
|
|
|
0RG00JJ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0RG00JJ
|
| Hospital Charge Code |
14446
|
| 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
|
|
