|
02C10ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1004
|
| 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
|
|
|
02C13Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1006
|
| 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
|
|
|
02C13Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1005
|
| 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
|
|
|
02C13ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1007
|
| 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
|
|
|
02C13ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1008
|
| 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
|
|
|
02C14Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1009
|
| 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
|
|
|
02C14ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1010
|
| 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
|
|
|
02C20Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1011
|
| 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
|
|
|
02C20ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1012
|
| 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
|
|
|
02C23Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1014
|
| 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
|
|
|
02C23Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1013
|
| 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
|
|
|
02C23ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1016
|
| 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
|
|
|
02C23ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1015
|
| 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
|
|
|
02C24Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1017
|
| 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
|
|
|
02C24ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1018
|
| 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
|
|
|
02C30Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1019
|
| 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
|
|
|
02C30ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1020
|
| 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
|
|
|
02C33Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1022
|
| 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
|
|
|
02C33Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1021
|
| 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
|
|
|
02C33ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1024
|
| 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
|
|
|
02C33ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1023
|
| 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
|
|
|
02C34Z6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1025
|
| 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
|
|
|
02C34ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1026
|
| 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
|
|
|
02C40ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1027
|
| 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
|
|
|
02C50ZZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1028
|
| 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
|
|
