|
02H23DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3155
|
| 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
|
|
|
02H23YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1054
|
| 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
|
|
|
02H24DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3156
|
| 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
|
|
|
02H24YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1055
|
| 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
|
|
|
02H30DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3157
|
| 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
|
|
|
02H30YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1056
|
| 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
|
|
|
02H33DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3158
|
| 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
|
|
|
02H33YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1057
|
| 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
|
|
|
02H34DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
3159
|
| 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
|
|
|
02H34YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1058
|
| 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
|
|
|
02H400Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1059
|
| 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
|
|
|
02H402Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1060
|
| 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
|
|
|
02H403Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3160
|
| 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
|
|
|
02H40DZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1061
|
| 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
|
|
|
02H40KZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1063
|
| 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
|
|
|
02H40YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1065
|
| 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
|
|
|
02H430Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1066
|
| 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
|
|
|
02H432Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1067
|
| 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
|
|
|
02H433Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3161
|
| 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
|
|
|
02H43DZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3162
|
| 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
|
|
|
02H43YZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1070
|
| 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
|
|
|
02H440Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1071
|
| 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
|
|
|
02H442Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
1072
|
| 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
|
|
|
02H443Z
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3163
|
| 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
|
|
|
02H44DZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3164
|
| 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
|
|
