|
0HHX31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0HHX31Z
|
| Hospital Charge Code |
4994
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0HHX71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0HHX71Z
|
| Hospital Charge Code |
4995
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0HHX81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0HHX81Z
|
| Hospital Charge Code |
4996
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0HHXX1Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0HHXX1Z
|
| Hospital Charge Code |
4997
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
2537
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
2536
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
2539
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
2538
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH60AZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH60AZ
|
| Hospital Charge Code |
2540
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH60BZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH60BZ
|
| Hospital Charge Code |
2541
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH60CZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH60CZ
|
| Hospital Charge Code |
2542
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH60DZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH60DZ
|
| Hospital Charge Code |
2543
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH60EZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH60EZ
|
| Hospital Charge Code |
2544
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH60FZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH60FZ
|
| Hospital Charge Code |
2545
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH60MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH60MZ
|
| Hospital Charge Code |
2546
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH638Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH638Z
|
| Hospital Charge Code |
2552
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH638Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH638Z
|
| Hospital Charge Code |
2553
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH639Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH639Z
|
| Hospital Charge Code |
2554
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH639Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH639Z
|
| Hospital Charge Code |
2555
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH63AZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH63AZ
|
| Hospital Charge Code |
2556
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH63BZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH63BZ
|
| Hospital Charge Code |
2557
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH63EZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH63EZ
|
| Hospital Charge Code |
2560
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH63FZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH63FZ
|
| Hospital Charge Code |
2561
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0JH63MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH63MZ
|
| Hospital Charge Code |
2562
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0JH70BZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70BZ
|
| Hospital Charge Code |
2564
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
