|
0JHW31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0JHW31Z
|
| Hospital Charge Code |
5019
|
| 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
|
|
|
0JPT0FZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT0FZ
|
| Hospital Charge Code |
2604
|
| 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
|
|
|
0JPT0MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JPT0MZ
|
| Hospital Charge Code |
2605
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2608
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2607
|
| 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
|
|
|
0JPT0PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT0PZ
|
| Hospital Charge Code |
2606
|
| 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
|
|
|
0JPT3FZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT3FZ
|
| Hospital Charge Code |
2609
|
| 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
|
|
|
0JPT3MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 0JPT3MZ
|
| Hospital Charge Code |
2610
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2613
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2611
|
| 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
|
|
|
0JPT3PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JPT3PZ
|
| Hospital Charge Code |
2612
|
| 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
|
|
|
0JWT0PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JWT0PZ
|
| Hospital Charge Code |
2614
|
| 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
|
|
|
0JWT0PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JWT0PZ
|
| Hospital Charge Code |
2615
|
| 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
|
|
|
0JWT3PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JWT3PZ
|
| Hospital Charge Code |
2616
|
| 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
|
|
|
0JWT3PZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0JWT3PZ
|
| Hospital Charge Code |
2617
|
| 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
|
|
|
0Q820ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0Q820ZZ
|
| Hospital Charge Code |
2618
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
0Q834ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0Q834ZZ
|
| Hospital Charge Code |
2619
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
0QPD0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QPD0JZ
|
| Hospital Charge Code |
5020
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QPD3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QPD3JZ
|
| Hospital Charge Code |
5021
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QPD4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QPD4JZ
|
| Hospital Charge Code |
5022
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QPF0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QPF0JZ
|
| Hospital Charge Code |
5023
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QPF3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QPF3JZ
|
| Hospital Charge Code |
5024
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QPF4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QPF4JZ
|
| Hospital Charge Code |
5025
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QRD0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QRD0JZ
|
| Hospital Charge Code |
5026
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QRD3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QRD3JZ
|
| Hospital Charge Code |
5027
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
