|
09HE3SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2515
|
| 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
|
|
|
09HE45Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2516
|
| 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
|
|
|
09HE46Z
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2517
|
| 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
|
|
|
09HE4SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2518
|
| 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
|
|
|
09PD0SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2519
|
| 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
|
|
|
09PD7SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2520
|
| 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
|
|
|
09PD8SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2521
|
| 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
|
|
|
09PE0SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2522
|
| 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
|
|
|
09PE7SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2523
|
| 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
|
|
|
09PE8SZ
|
Facility
|
IP
|
$30,379.00
|
|
| Hospital Charge Code |
2524
|
| 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
|
|
|
0DH60MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2525
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0DH63MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2526
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0DH64MZ
|
Facility
|
IP
|
$30,092.00
|
|
| Hospital Charge Code |
2527
|
| Min. Negotiated Rate |
$30,092.00 |
| Max. Negotiated Rate |
$30,092.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,092.00
|
|
|
0DQP0ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2528
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0DQP8ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2529
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0DQR0ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2530
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0DQR4ZZ
|
Facility
|
IP
|
$11,523.00
|
|
| Hospital Charge Code |
2531
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0JH604Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2532
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH605Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2533
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH606Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2534
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH607Z
|
Facility
|
IP
|
$14,428.00
|
|
| Hospital Charge Code |
2535
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2537
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2536
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2538
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$45,565.00
|
|
| Hospital Charge Code |
2539
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
