|
04H042Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2451
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04U03JZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2452
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04U04JZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2453
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V00DJ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2454
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V00EZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2455
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V00FZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2456
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V03DJ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2457
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V03DZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
4625
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V03EZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2458
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V03FZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2459
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V04DJ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2460
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V04DZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
4626
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V04EZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2461
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
04V04FZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2462
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
05700DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4627
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05703DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4628
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05704DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4629
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05710DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4630
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05713DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4631
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05714DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4632
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05730D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4633
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05730DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4634
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05733D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4635
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05733DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4636
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
05734D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4637
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
