02734Z6
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
881
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
02734ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
882
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027F04Z
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3076
|
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
|
|
027F0DZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
883
|
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
|
|
027F0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3077
|
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
|
|
027F34Z
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
884
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027F3DZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
885
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027F3ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
886
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027F44Z
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
887
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027F4DZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
888
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027F4ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
889
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027G04Z
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3078
|
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
|
|
027G0DZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
890
|
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
|
|
027G0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3079
|
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
|
|
027G34Z
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
891
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027G3DZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
892
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027G3ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
893
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027G44Z
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
894
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027G4DZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
895
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027G4ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
896
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027H04Z
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3080
|
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
|
|
027H0DZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
897
|
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
|
|
027H0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3081
|
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
|
|
027H34Z
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
898
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
027H3DZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
899
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|