|
047J3FZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4384
|
| 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
|
|
|
047J3GZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4385
|
| 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
|
|
|
047J441
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2206
|
| 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
|
|
|
047J44Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2207
|
| 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
|
|
|
047J45Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2208
|
| 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
|
|
|
047J46Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2209
|
| 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
|
|
|
047J47Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2210
|
| 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
|
|
|
047J4D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4386
|
| 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
|
|
|
047J4D6
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4387
|
| 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
|
|
|
047J4DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4388
|
| 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
|
|
|
047J4EZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4389
|
| 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
|
|
|
047J4FZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4390
|
| 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
|
|
|
047J4GZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4391
|
| 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
|
|
|
047K041
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2211
|
| 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
|
|
|
047K04Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2212
|
| 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
|
|
|
047K05Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2213
|
| 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
|
|
|
047K06Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2214
|
| 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
|
|
|
047K07Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2215
|
| 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
|
|
|
047K0D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4392
|
| 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
|
|
|
047K0D6
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4393
|
| 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
|
|
|
047K0DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4394
|
| 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
|
|
|
047K0EZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4395
|
| 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
|
|
|
047K0FZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4396
|
| 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
|
|
|
047K0GZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4397
|
| 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
|
|
|
047K341
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2216
|
| 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
|
|
