02WM0JZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3566
|
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
|
|
02WM4JZ
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3567
|
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
|
|
02YA0Z0
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1540
|
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
|
|
02YA0Z1
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3568
|
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
|
|
02YA0Z2
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3569
|
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
|
|
03130AM
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
1542
|
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
|
|
03130AN
|
Facility
|
IP
|
$10,777.00
|
|
Hospital Charge Code |
3570
|
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
|
|
037004Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1551
|
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
|
|
037005Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1552
|
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
|
|
037006Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1553
|
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
|
|
037007Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1554
|
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
|
|
03700D1
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3571
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03700D6
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3572
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03700DZ
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3573
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03700EZ
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3574
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03700FZ
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3575
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03700GZ
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3576
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
037034Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1555
|
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
|
|
037035Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1556
|
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
|
|
037036Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1557
|
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
|
|
037037Z
|
Facility
|
IP
|
$8,623.00
|
|
Hospital Charge Code |
1558
|
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
|
|
03703D1
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3577
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03703D6
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3578
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03703DZ
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3579
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
03703EZ
|
Facility
|
IP
|
$3,913.00
|
|
Hospital Charge Code |
3580
|
Min. Negotiated Rate |
$3,913.00 |
Max. Negotiated Rate |
$3,913.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|