|
02U047Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1354
|
| 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
|
|
|
02U048Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1355
|
| 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
|
|
|
02U04JZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1356
|
| 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
|
|
|
02U04KZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1357
|
| 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
|
|
|
02U107Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1358
|
| 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
|
|
|
02U108Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1359
|
| 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
|
|
|
02U10JZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1360
|
| 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
|
|
|
02U10KZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1361
|
| 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
|
|
|
02U137Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1362
|
| 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
|
|
|
02U138Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1363
|
| 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
|
|
|
02U13JZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1364
|
| 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
|
|
|
02U13KZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1365
|
| 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
|
|
|
02U147Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1366
|
| 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
|
|
|
02U148Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1367
|
| 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
|
|
|
02U14JZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1368
|
| 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
|
|
|
02U14KZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1369
|
| 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
|
|
|
02U207Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1370
|
| 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
|
|
|
02U208Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1371
|
| 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
|
|
|
02U20JZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1372
|
| 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
|
|
|
02U20KZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1373
|
| 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
|
|
|
02U237Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1374
|
| 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
|
|
|
02U238Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1375
|
| 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
|
|
|
02U23JZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1376
|
| 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
|
|
|
02U23KZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1377
|
| 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
|
|
|
02U247Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
1378
|
| 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
|
|
