|
027R0DT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
929
|
| 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
|
|
|
027R0ZT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
930
|
| 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
|
|
|
027R34T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
931
|
| 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
|
|
|
027R34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
932
|
| 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
|
|
|
027R3DT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
933
|
| 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
|
|
|
027R3ZT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
934
|
| 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
|
|
|
027R44T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
935
|
| 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
|
|
|
027R44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
936
|
| 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
|
|
|
027R4DT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
937
|
| 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
|
|
|
027R4ZT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
938
|
| 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
|
|
|
027S04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
939
|
| 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
|
|
|
027S34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
940
|
| 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
|
|
|
027S44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
941
|
| 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
|
|
|
027T04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
942
|
| 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
|
|
|
027T34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
943
|
| 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
|
|
|
027T44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
944
|
| 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
|
|
|
027V04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
945
|
| 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
|
|
|
027V34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
946
|
| 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
|
|
|
027V44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
947
|
| 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
|
|
|
027W04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
948
|
| 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
|
|
|
027W34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
949
|
| 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
|
|
|
027W44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
950
|
| 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
|
|
|
027X04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
951
|
| 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
|
|
|
027X34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
952
|
| 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
|
|
|
027X44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
953
|
| 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
|
|
