02BL3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
989
|
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
|
|
02BL4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
990
|
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
|
|
02BM0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
991
|
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
|
|
02BN0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
992
|
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
|
|
02BN3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
993
|
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
|
|
02BN4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
994
|
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
|
|
02C00Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
995
|
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
|
|
02C00ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
996
|
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
|
|
02C03Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
998
|
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
|
|
02C03Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
997
|
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
|
|
02C03ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
999
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$10,777.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
02C03ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1000
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$10,777.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
02C04Z6
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1001
|
Min. Negotiated Rate |
$9,888.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
|
02C04ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1002
|
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
|
|
02C10Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1003
|
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
|
|
02C10ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1004
|
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
|
|
02C13Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1005
|
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
|
|
02C13Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1006
|
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
|
|
02C13ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1008
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$10,777.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
02C13ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1007
|
Min. Negotiated Rate |
$4,968.00 |
Max. Negotiated Rate |
$10,777.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
02C14Z6
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1009
|
Min. Negotiated Rate |
$9,888.00 |
Max. Negotiated Rate |
$9,888.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
|
02C14ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1010
|
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
|
|
02C20Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1011
|
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
|
|
02C20ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1012
|
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
|
|
02C23Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1014
|
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
|
|