|
03CJ3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1923
|
| 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
|
|
|
03CK3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1924
|
| 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
|
|
|
03CK3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1925
|
| 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
|
|
|
03CL3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1926
|
| 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
|
|
|
03CL3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1927
|
| 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
|
|
|
03CM3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1928
|
| 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
|
|
|
03CM3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1929
|
| 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
|
|
|
03CN3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1930
|
| 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
|
|
|
03CN3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1931
|
| 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
|
|
|
03CP3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1932
|
| 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
|
|
|
03CP3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1933
|
| 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
|
|
|
03CQ3Z7
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1934
|
| 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
|
|
|
03CQ3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1935
|
| 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
|
|
|
03CR3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1936
|
| 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
|
|
|
03CS3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1937
|
| 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
|
|
|
03CT3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1938
|
| 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
|
|
|
03CU3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1939
|
| 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
|
|
|
03CV3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1940
|
| 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
|
|
|
03CY3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1941
|
| 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
|
|
|
0470041
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
1942
|
| 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
|
|
|
047004Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
1943
|
| 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
|
|
|
047005Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
1944
|
| 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
|
|
|
047006Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
1945
|
| 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
|
|
|
047007Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
1946
|
| 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
|
|
|
04700D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4067
|
| 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
|
|
