|
X2RF032
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2778
|
| 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
|
|
|
X2RF332
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2779
|
| 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
|
|
|
X2RF432
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2780
|
| 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
|
|
|
XRG0092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2781
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG00F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2782
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG1092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2783
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG10F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2784
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG2092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2785
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG20F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2786
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG4092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2787
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG40F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2788
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG6092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2789
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG60F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2790
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG7092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2791
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG70F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2792
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG8092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2793
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRG80F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2794
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGA092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2795
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGA0F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2796
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGB092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2797
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGB0F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2798
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGC092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2799
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGC0F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2800
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGD092
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2801
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
XRGD0F3
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2802
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
