|
02124KC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
258
|
| 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
|
|
|
02124KF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2870
|
| 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
|
|
|
02124KW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2871
|
| 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
|
|
|
02124Z3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
259
|
| 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
|
|
|
02124Z8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
260
|
| 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
|
|
|
02124Z9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
261
|
| 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
|
|
|
02124ZC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
262
|
| 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
|
|
|
02124ZF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2872
|
| 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
|
|
|
0213083
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
263
|
| 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
|
|
|
0213088
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
264
|
| 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
|
|
|
0213089
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
265
|
| 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
|
|
|
021308C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
266
|
| 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
|
|
|
021308F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
267
|
| 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
|
|
|
021308W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
268
|
| 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
|
|
|
0213093
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
269
|
| 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
|
|
|
0213098
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
270
|
| 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
|
|
|
0213099
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2873
|
| 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
|
|
|
021309C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2874
|
| 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
|
|
|
021309F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2875
|
| 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
|
|
|
021309W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2876
|
| 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
|
|
|
02130A3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
271
|
| 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
|
|
|
02130A8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
272
|
| 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
|
|
|
02130A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
273
|
| 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
|
|
|
02130AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
274
|
| 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
|
|
|
02130AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2877
|
| 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
|
|
