|
047A45Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2104
|
| 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
|
|
|
047A46Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2105
|
| 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
|
|
|
047A47Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2106
|
| 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
|
|
|
047B041
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2107
|
| 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
|
|
|
047B04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2108
|
| 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
|
|
|
047B05Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2109
|
| 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
|
|
|
047B06Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2110
|
| 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
|
|
|
047B07Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2111
|
| 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
|
|
|
047B341
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2112
|
| 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
|
|
|
047B34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2113
|
| 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
|
|
|
047B35Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2114
|
| 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
|
|
|
047B36Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2115
|
| 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
|
|
|
047B37Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2116
|
| 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
|
|
|
047B441
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2117
|
| 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
|
|
|
047B44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2118
|
| 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
|
|
|
047B45Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2119
|
| 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
|
|
|
047B46Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2120
|
| 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
|
|
|
047B47Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2121
|
| 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
|
|
|
047C041
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2122
|
| 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
|
|
|
047C04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2123
|
| 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
|
|
|
047C05Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2124
|
| 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
|
|
|
047C06Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2125
|
| 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
|
|
|
047C07Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2126
|
| 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
|
|
|
047C341
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2127
|
| 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
|
|
|
047C34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2128
|
| 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
|
|
