|
02110KC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
154
|
| 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
|
|
|
02110KF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
155
|
| 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
|
|
|
02110Z3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
156
|
| 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
|
|
|
02110Z8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
157
|
| 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
|
|
|
02110Z9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
158
|
| 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
|
|
|
02110ZC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
159
|
| 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
|
|
|
02110ZF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
160
|
| 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
|
|
|
02113D4
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
161
|
| 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
|
|
|
0211444
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
162
|
| 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
|
|
|
0211483
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
163
|
| 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
|
|
|
0211488
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
164
|
| 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
|
|
|
0211489
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
165
|
| 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
|
|
|
021148C
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
166
|
| 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
|
|
|
021148F
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
167
|
| 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
|
|
|
021148W
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
168
|
| 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
|
|
|
0211493
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
169
|
| 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
|
|
|
0211498
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
170
|
| 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
|
|
|
0211499
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
171
|
| 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
|
|
|
021149C
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
172
|
| 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
|
|
|
021149F
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
173
|
| 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
|
|
|
02114A3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
174
|
| 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
|
|
|
02114A8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
175
|
| 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
|
|
|
02114A9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
176
|
| 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
|
|
|
02114AC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
177
|
| 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
|
|
|
02114AF
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
178
|
| 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
|
|
