|
02104ZF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
129
|
| 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
|
|
|
0211083
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
130
|
| 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
|
|
|
0211088
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
131
|
| 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
|
|
|
0211089
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
132
|
| 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
|
|
|
021108C
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
133
|
| 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
|
|
|
021108F
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
134
|
| 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
|
|
|
021108W
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
135
|
| 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
|
|
|
0211093
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
136
|
| 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
|
|
|
0211098
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
137
|
| 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
|
|
|
0211099
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
138
|
| 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
|
|
|
021109C
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
139
|
| 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
|
|
|
021109F
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
140
|
| 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
|
|
|
02110A3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
141
|
| 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
|
|
|
02110A8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
142
|
| 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
|
|
|
02110A9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
143
|
| 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
|
|
|
02110AC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
144
|
| 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
|
|
|
02110AF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
145
|
| 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
|
|
|
02110J3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
146
|
| 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
|
|
|
02110J8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
147
|
| 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
|
|
|
02110J9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
148
|
| 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
|
|
|
02110JC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
149
|
| 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
|
|
|
02110JF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
150
|
| 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
|
|
|
02110K3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
151
|
| 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
|
|
|
02110K8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
152
|
| 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
|
|
|
02110K9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
153
|
| 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
|
|
