|
00H00MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
54
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00H60MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
55
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HE0MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
56
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HE3MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
57
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HE4MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
58
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HU0MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
59
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HU3MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
60
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HU4MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
61
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HV0MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
62
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HV3MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
63
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00HV4MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
64
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00PV0MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
65
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00PV3MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
66
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
00PV4MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
67
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
01HY0MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
68
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
01HY3MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
69
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
01HY4MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
70
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0210083
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2819
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0210088
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2818
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0210089
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2820
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021008C
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
74
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021008F
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
75
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021008W
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
76
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0210093
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2821
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0210098
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2822
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
