|
02124JW
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
254
|
| 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
|
|
|
02124K3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
255
|
| 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
|
|
|
02124K8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
256
|
| 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
|
|
|
02124K9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
257
|
| 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
|
|
|
02124KC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
258
|
| 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
|
|
|
02124Z3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
259
|
| 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
|
|
|
02124Z8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
260
|
| 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
|
|
|
02124Z9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
261
|
| 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
|
|
|
02124ZC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
262
|
| 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
|
|
|
0213083
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
263
|
| 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
|
|
|
0213088
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
264
|
| 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
|
|
|
0213089
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
265
|
| 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
|
|
|
021308C
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
266
|
| 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
|
|
|
021308F
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
267
|
| 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
|
|
|
021308W
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
268
|
| 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
|
|
|
0213093
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
269
|
| 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
|
|
|
0213098
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
270
|
| 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
|
|
|
02130A3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
271
|
| 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
|
|
|
02130A8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
272
|
| 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
|
|
|
02130A9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
273
|
| 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
|
|
|
02130AC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
274
|
| 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
|
|
|
02130J3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
275
|
| 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
|
|
|
02130J8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
276
|
| 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
|
|
|
02130J9
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
277
|
| 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
|
|
|
02130JC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
278
|
| 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
|
|
