|
021248C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
234
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021248F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
235
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021248W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
236
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0212493
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
237
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0212498
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
238
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0212499
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
239
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021249C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
240
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021249F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
241
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021249W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
242
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124A3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
243
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124A8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
244
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
245
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
246
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
247
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124AW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
248
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124D4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
249
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124J3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
250
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124J8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
251
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124J9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
252
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124JC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
253
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124JF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2869
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124JW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
254
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124K3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
255
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124K8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
256
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02124K9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
257
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
