|
057Y0DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4738
|
| 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
|
|
|
057Y3DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4739
|
| 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
|
|
|
057Y4DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4740
|
| 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
|
|
|
061007P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2463
|
| 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
|
|
|
061007Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2464
|
| 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
|
|
|
061007R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2465
|
| 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
|
|
|
061009P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2466
|
| 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
|
|
|
061009Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2467
|
| 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
|
|
|
061009R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2468
|
| 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
|
|
|
06100AP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2469
|
| 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
|
|
|
06100AQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2470
|
| 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
|
|
|
06100AR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2471
|
| 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
|
|
|
06100JP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2472
|
| 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
|
|
|
06100JQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2473
|
| 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
|
|
|
06100JR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2474
|
| 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
|
|
|
06100KP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2475
|
| 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
|
|
|
06100KQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2476
|
| 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
|
|
|
06100KR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2477
|
| 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
|
|
|
06100ZP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2478
|
| 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
|
|
|
06100ZQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2479
|
| 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
|
|
|
06100ZR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2480
|
| 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
|
|
|
061047P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2481
|
| 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
|
|
|
061047Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2482
|
| 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
|
|
|
061047R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2483
|
| 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
|
|
|
061049P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2484
|
| 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
|
|
