|
0JH809Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2585
|
| 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
|
|
|
0JH809Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2584
|
| 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
|
|
|
0JH80AZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2586
|
| 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
|
|
|
0JH80BZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2587
|
| 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
|
|
|
0JH80CZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
5008
|
| 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
|
|
|
0JH80DZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
5009
|
| 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
|
|
|
0JH80EZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2588
|
| 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
|
|
|
0JH80MZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2589
|
| 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
|
|
|
0JH838Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2596
|
| 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
|
|
|
0JH838Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2595
|
| 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
|
|
|
0JH839Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2598
|
| 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
|
|
|
0JH839Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2597
|
| 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
|
|
|
0JH83AZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2599
|
| 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
|
|
|
0JH83BZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2600
|
| 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
|
|
|
0JH83CZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
5010
|
| 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
|
|
|
0JH83DZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
5011
|
| 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
|
|
|
0JH83EZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2601
|
| 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
|
|
|
0JH83MZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2602
|
| 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
|
|
|
0JHS01Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5012
|
| 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
|
|
|
0JHS31Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5013
|
| 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
|
|
|
0JHT01Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5014
|
| 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
|
|
|
0JHT31Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5015
|
| 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
|
|
|
0JHV01Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5016
|
| 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
|
|
|
0JHV31Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5017
|
| 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
|
|
|
0JHW01Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5018
|
| 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
|
|
