|
06104JP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2490
|
| 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
|
|
|
06104JQ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2491
|
| 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
|
|
|
06104JR
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2492
|
| 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
|
|
|
06104KP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2493
|
| 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
|
|
|
06104KQ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2494
|
| 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
|
|
|
06104KR
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2495
|
| 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
|
|
|
06104ZP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2496
|
| 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
|
|
|
06104ZQ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2497
|
| 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
|
|
|
06104ZR
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2498
|
| 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
|
|
|
06183J4
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2499
|
| 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
|
|
|
06183JY
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2500
|
| 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
|
|
|
06184J4
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2501
|
| 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
|
|
|
09HD05Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2502
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD06Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2503
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD0SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2504
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD35Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2505
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD36Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2506
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD3SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2507
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD45Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2508
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD46Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2509
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HD4SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2510
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HE05Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2511
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HE06Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2512
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HE0SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2513
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
|
09HE35Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2514
|
| Min. Negotiated Rate |
$30,379.00 |
| Max. Negotiated Rate |
$30,379.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,379.00
|
|
