|
037Y4D6
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4062
|
| 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
|
|
|
037Y4DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4063
|
| 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
|
|
|
037Y4EZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4064
|
| 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
|
|
|
037Y4FZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4065
|
| 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
|
|
|
037Y4GZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4066
|
| 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
|
|
|
03C03ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1903
|
| 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
|
|
|
03C13ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1904
|
| 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
|
|
|
03C23ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1905
|
| 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
|
|
|
03C33ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1906
|
| 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
|
|
|
03C43ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1907
|
| 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
|
|
|
03C53ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1908
|
| 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
|
|
|
03C63ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1909
|
| 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
|
|
|
03C73ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1910
|
| 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
|
|
|
03C83ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1911
|
| 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
|
|
|
03C93ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1912
|
| 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
|
|
|
03CA3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1913
|
| 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
|
|
|
03CB3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1914
|
| 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
|
|
|
03CC3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1915
|
| 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
|
|
|
03CD3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1916
|
| 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
|
|
|
03CF3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1917
|
| 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
|
|
|
03CG3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1918
|
| 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
|
|
|
03CG3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1919
|
| 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
|
|
|
03CH3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1920
|
| 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
|
|
|
03CH3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1921
|
| 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
|
|
|
03CJ3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1922
|
| 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
|
|
