|
0JH70CZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70CZ
|
| Hospital Charge Code |
4998
|
| 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
|
|
|
0JH70DZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70DZ
|
| Hospital Charge Code |
4999
|
| 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
|
|
|
0JH70EZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70EZ
|
| Hospital Charge Code |
5000
|
| 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
|
|
|
0JH70FZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70FZ
|
| Hospital Charge Code |
5001
|
| 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
|
|
|
0JH70GZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70GZ
|
| Hospital Charge Code |
5002
|
| 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
|
|
|
0JH70HZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70HZ
|
| Hospital Charge Code |
5003
|
| 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
|
|
|
0JH70IZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70IZ
|
| Hospital Charge Code |
5004
|
| 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
|
|
|
0JH70JZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70JZ
|
| Hospital Charge Code |
5005
|
| 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
|
|
|
0JH70KZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70KZ
|
| Hospital Charge Code |
5006
|
| 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
|
|
|
0JH70LZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70LZ
|
| Hospital Charge Code |
5007
|
| 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
|
|
|
0JH70MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH70MZ
|
| Hospital Charge Code |
2565
|
| 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
|
|
|
0JH73BZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73BZ
|
| Hospital Charge Code |
2566
|
| 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
|
|
|
0JH73CZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73CZ
|
| Hospital Charge Code |
2567
|
| 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
|
|
|
0JH73DZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73DZ
|
| Hospital Charge Code |
2568
|
| 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
|
|
|
0JH73EZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73EZ
|
| Hospital Charge Code |
2569
|
| 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
|
|
|
0JH73FZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73FZ
|
| Hospital Charge Code |
2570
|
| 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
|
|
|
0JH73GZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73GZ
|
| Hospital Charge Code |
2571
|
| 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
|
|
|
0JH73HZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73HZ
|
| Hospital Charge Code |
2572
|
| 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
|
|
|
0JH73IZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73IZ
|
| Hospital Charge Code |
2573
|
| 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
|
|
|
0JH73JZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73JZ
|
| Hospital Charge Code |
2574
|
| 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
|
|
|
0JH73KZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73KZ
|
| Hospital Charge Code |
2575
|
| 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
|
|
|
0JH73LZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73LZ
|
| Hospital Charge Code |
2576
|
| 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
|
|
|
0JH73MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JH73MZ
|
| Hospital Charge Code |
2577
|
| 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
|
|
|
0JH808Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH808Z
|
| Hospital Charge Code |
2582
|
| 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
|
|
|
0JH808Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JH808Z
|
| Hospital Charge Code |
2583
|
| 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
|
|
