|
047R05Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2304
|
| 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
|
|
|
047R06Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2305
|
| 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
|
|
|
047R07Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2306
|
| 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
|
|
|
047R341
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2307
|
| 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
|
|
|
047R34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2308
|
| 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
|
|
|
047R35Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2309
|
| 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
|
|
|
047R36Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2310
|
| 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
|
|
|
047R37Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2311
|
| 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
|
|
|
047R441
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2312
|
| 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
|
|
|
047R44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2313
|
| 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
|
|
|
047R45Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2314
|
| 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
|
|
|
047R46Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2315
|
| 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
|
|
|
047R47Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2316
|
| 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
|
|
|
047S041
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2317
|
| 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
|
|
|
047S04Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2318
|
| 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
|
|
|
047S05Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2319
|
| 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
|
|
|
047S06Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2320
|
| 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
|
|
|
047S07Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2321
|
| 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
|
|
|
047S341
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2322
|
| 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
|
|
|
047S34Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2323
|
| 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
|
|
|
047S35Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2324
|
| 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
|
|
|
047S36Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2325
|
| 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
|
|
|
047S37Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2326
|
| 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
|
|
|
047S441
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2327
|
| 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
|
|
|
047S44Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2328
|
| 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
|
|
