|
0210099
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2823
|
| 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
|
|
|
021009C
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
80
|
| 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
|
|
|
021009F
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
81
|
| 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
|
|
|
02100A3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
82
|
| 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
|
|
|
02100A8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
83
|
| 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
|
|
|
02100A9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
84
|
| 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
|
|
|
02100AC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
85
|
| 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
|
|
|
02100AF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
86
|
| 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
|
|
|
02100J3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
87
|
| 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
|
|
|
02100J8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
88
|
| 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
|
|
|
02100J9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
89
|
| 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
|
|
|
02100JC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
90
|
| 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
|
|
|
02100JF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
91
|
| 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
|
|
|
02100K3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
92
|
| 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
|
|
|
02100K8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
93
|
| 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
|
|
|
02100K9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
94
|
| 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
|
|
|
02100KC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
95
|
| 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
|
|
|
02100KF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
96
|
| 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
|
|
|
02100Z3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
97
|
| 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
|
|
|
02100Z8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
98
|
| 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
|
|
|
02100Z9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
99
|
| 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
|
|
|
02100ZC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
100
|
| 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
|
|
|
02100ZF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
101
|
| 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
|
|
|
02103D4
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
102
|
| 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
|
|
|
0210444
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
103
|
| 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
|
|
