|
0UQM0ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2686
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0UQMXZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2687
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0UT24ZZ
|
Facility
|
IP
|
$26,431.00
|
|
| Hospital Charge Code |
2688
|
| Min. Negotiated Rate |
$26,431.00 |
| Max. Negotiated Rate |
$26,431.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,431.00
|
|
|
0UT74ZZ
|
Facility
|
IP
|
$26,431.00
|
|
| Hospital Charge Code |
2689
|
| Min. Negotiated Rate |
$26,431.00 |
| Max. Negotiated Rate |
$26,431.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,431.00
|
|
|
0UT94ZZ
|
Facility
|
IP
|
$26,431.00
|
|
| Hospital Charge Code |
2690
|
| Min. Negotiated Rate |
$26,431.00 |
| Max. Negotiated Rate |
$26,431.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,431.00
|
|
|
0UT9FZL
|
Facility
|
IP
|
$26,431.00
|
|
| Hospital Charge Code |
2691
|
| Min. Negotiated Rate |
$26,431.00 |
| Max. Negotiated Rate |
$26,431.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,431.00
|
|
|
0UT9FZZ
|
Facility
|
IP
|
$26,431.00
|
|
| Hospital Charge Code |
2692
|
| Min. Negotiated Rate |
$26,431.00 |
| Max. Negotiated Rate |
$26,431.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,431.00
|
|
|
0UTC4ZZ
|
Facility
|
IP
|
$26,431.00
|
|
| Hospital Charge Code |
2693
|
| Min. Negotiated Rate |
$26,431.00 |
| Max. Negotiated Rate |
$26,431.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,431.00
|
|
|
0VT00ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2694
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT01ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2695
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT02ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2696
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT03ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2697
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT04ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2698
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT05ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2699
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT06ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2700
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT07ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2701
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT08ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2702
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT30ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2703
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT31ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2704
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT32ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2705
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT33ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2706
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0VT34ZZ
|
Facility
|
IP
|
$27,340.00
|
|
| Hospital Charge Code |
2707
|
| Min. Negotiated Rate |
$27,340.00 |
| Max. Negotiated Rate |
$27,340.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,340.00
|
|
|
0W8NXZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2708
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0W9D0ZX
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2709
|
| 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
|
|
|
0WCD0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2710
|
| 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
|
|
