02C23Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1013
|
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
|
|
02C23ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1016
|
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
|
|
02C23ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1015
|
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
|
|
02C24Z6
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1017
|
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
|
|
02C24ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1018
|
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
|
|
02C30Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1019
|
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
|
|
02C30ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1020
|
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
|
|
02C33Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1022
|
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
|
|
02C33Z6
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1021
|
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
|
|
02C33ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1024
|
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
|
|
02C33ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1023
|
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
|
|
02C34Z6
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1025
|
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
|
|
02C34ZZ
|
Facility
|
IP
|
$9,888.00
|
|
Hospital Charge Code |
1026
|
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
|
|
02C40ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1027
|
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
|
|
02C43ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3120
|
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
|
|
02C44ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3121
|
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
|
|
02C50ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1028
|
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
|
|
02C53ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3122
|
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
|
|
02C54ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3123
|
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
|
|
02C60ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1029
|
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
|
|
02C63ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3124
|
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
|
|
02C64ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3125
|
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
|
|
02C70ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3126
|
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
|
|
02C73ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3127
|
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
|
|
02C74ZZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3128
|
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
|
|