|
02733F6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
855
|
| 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
|
|
|
02733FZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
856
|
| 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
|
|
|
02733G6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
857
|
| 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
|
|
|
02733GZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
858
|
| 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
|
|
|
02733T6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
859
|
| 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
|
|
|
02733TZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
860
|
| 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
|
|
|
02733Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
861
|
| 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
|
|
|
02733ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
862
|
| 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
|
|
|
0273446
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
863
|
| 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
|
|
|
027344Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
864
|
| 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
|
|
|
0273456
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
865
|
| 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
|
|
|
027345Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
866
|
| 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
|
|
|
0273466
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
867
|
| 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
|
|
|
027346Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
868
|
| 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
|
|
|
0273476
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
869
|
| 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
|
|
|
027347Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
870
|
| 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
|
|
|
02734D6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
871
|
| 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
|
|
|
02734DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
872
|
| 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
|
|
|
02734E6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
3075
|
| 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
|
|
|
02734E6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
3074
|
| 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
|
|
|
02734EZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
874
|
| 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
|
|
|
02734F6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
875
|
| 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
|
|
|
02734FZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
876
|
| 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
|
|
|
02734G6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
877
|
| 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
|
|
|
02734GZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
878
|
| 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
|
|
