|
02170ZQ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
379
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02170ZR
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
380
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02170ZS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
381
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02170ZT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
382
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02170ZU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
383
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02173J6
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
384
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021748P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
385
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021748Q
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
386
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021748R
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
387
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021748S
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
388
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021748T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
389
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021748U
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
390
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021749S
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
391
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021749T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
392
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021749U
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
393
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174AP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
394
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174AQ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
395
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174AR
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
396
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174AS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
397
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174AT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
398
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174AU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
399
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174JS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
400
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174JT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
401
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174JU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
402
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02174KS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
403
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
