|
02570ZK
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
560
|
| 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
|
|
|
02570ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
561
|
| 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
|
|
|
02573ZK
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
562
|
| 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
|
|
|
02574ZK
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
563
|
| 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
|
|
|
02580ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
564
|
| 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
|
|
|
02590ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
565
|
| 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
|
|
|
025D0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
566
|
| 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
|
|
|
025D3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3044
|
| 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
|
|
|
025D4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3045
|
| 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
|
|
|
025F0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
567
|
| 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
|
|
|
025G0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
568
|
| 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
|
|
|
025H0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
569
|
| 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
|
|
|
025J0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
570
|
| 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
|
|
|
025K0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
571
|
| 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
|
|
|
025L0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
572
|
| 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
|
|
|
025M0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
573
|
| 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
|
|
|
025N0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
574
|
| 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
|
|
|
025N3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3046
|
| 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
|
|
|
025N4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3047
|
| 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
|
|
|
0270046
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
575
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027004Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
578
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027004Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
577
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
0270056
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
579
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027005Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
582
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027005Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
581
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
