|
02734T6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
879
|
| 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
|
|
|
02734TZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
880
|
| 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
|
|
|
02734Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
881
|
| 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
|
|
|
02734ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
882
|
| 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
|
|
|
027F0DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
883
|
| 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
|
|
|
027F34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
884
|
| 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
|
|
|
027F3DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
885
|
| 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
|
|
|
027F3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
886
|
| 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
|
|
|
027F44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
887
|
| 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
|
|
|
027F4DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
888
|
| 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
|
|
|
027F4ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
889
|
| 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
|
|
|
027G0DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
890
|
| 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
|
|
|
027G34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
891
|
| 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
|
|
|
027G3DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
892
|
| 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
|
|
|
027G3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
893
|
| 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
|
|
|
027G44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
894
|
| 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
|
|
|
027G4DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
895
|
| 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
|
|
|
027G4ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
896
|
| 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
|
|
|
027H0DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
897
|
| 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
|
|
|
027H34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
898
|
| 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
|
|
|
027H3DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
899
|
| 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
|
|
|
027H3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
900
|
| 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
|
|
|
027H44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
901
|
| 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
|
|
|
027H4DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
902
|
| 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
|
|
|
027H4ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
903
|
| 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
|
|
