|
061049Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2485
|
| 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
|
|
|
061049R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2486
|
| 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
|
|
|
06104AP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2487
|
| 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
|
|
|
06104AQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2488
|
| 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
|
|
|
06104AR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2489
|
| 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
|
|
|
06104JP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2490
|
| 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
|
|
|
06104JQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2491
|
| 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
|
|
|
06104JR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2492
|
| 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
|
|
|
06104KP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2493
|
| 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
|
|
|
06104KQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2494
|
| 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
|
|
|
06104KR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2495
|
| 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
|
|
|
06104ZP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2496
|
| 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
|
|
|
06104ZQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2497
|
| 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
|
|
|
06104ZR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2498
|
| 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
|
|
|
06183J4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2499
|
| 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
|
|
|
06183JY
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2500
|
| 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
|
|
|
06184J4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2501
|
| 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
|
|
|
06700DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4741
|
| 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
|
|
|
06703DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4742
|
| 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
|
|
|
06704DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4743
|
| 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
|
|
|
06710DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4744
|
| 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
|
|
|
06713DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4745
|
| 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
|
|
|
06714DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4746
|
| 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
|
|
|
06720DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4747
|
| 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
|
|
|
06723DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4748
|
| 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
|
|
