|
02CP3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1038
|
| 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
|
|
|
02CQ3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1039
|
| 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
|
|
|
02CR3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1040
|
| 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
|
|
|
02CS3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1041
|
| 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
|
|
|
02CT3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1042
|
| 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
|
|
|
02CV3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1043
|
| 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
|
|
|
02CW3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1044
|
| 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
|
|
|
02CX3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1045
|
| 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
|
|
|
02FN0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1046
|
| 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
|
|
|
02FN3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3146
|
| 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
|
|
|
02FN4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3147
|
| 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
|
|
|
02H00DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3148
|
| 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
|
|
|
02H00YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1047
|
| 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
|
|
|
02H03DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3149
|
| 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
|
|
|
02H03YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1048
|
| 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
|
|
|
02H04DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3150
|
| 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
|
|
|
02H04YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1049
|
| 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
|
|
|
02H10DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3151
|
| 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
|
|
|
02H10YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1050
|
| 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
|
|
|
02H13DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3152
|
| 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
|
|
|
02H13YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1051
|
| 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
|
|
|
02H14DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3153
|
| 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
|
|
|
02H14YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1052
|
| 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
|
|
|
02H20DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3154
|
| 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
|
|
|
02H20YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1053
|
| 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
|
|
