|
4A033BC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2756
|
| 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
|
|
|
4A033BF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2757
|
| 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
|
|
|
4A040B1
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2758
|
| 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
|
|
|
4A040B3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2759
|
| 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
|
|
|
4A043B1
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2760
|
| 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
|
|
|
4A043B3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2761
|
| 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
|
|
|
4A130BC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2762
|
| 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
|
|
|
4A133BC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2763
|
| 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
|
|
|
4A140B1
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2764
|
| 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
|
|
|
4A140B3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2765
|
| 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
|
|
|
4A143B1
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2766
|
| 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
|
|
|
4A143B3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2767
|
| 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
|
|
|
5A02116
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2768
|
| 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
|
|
|
5A02116
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2769
|
| 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
|
|
|
5A0211D
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2770
|
| 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
|
|
|
5A02210
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
5378
|
| 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
|
|
|
5A02216
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2772
|
| 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
|
|
|
5A02216
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2771
|
| 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
|
|
|
5A0221D
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
5379
|
| 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
|
|
|
5A1213Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2773
|
| 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
|
|
|
5A1221Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
5380
|
| 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
|
|
|
5A1223Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
5381
|
| 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
|
|
|
5A1522F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
5382
|
| 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
|
|
|
5A1522G
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
5383
|
| 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
|
|
|
5A1522H
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
5384
|
| 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
|
|
