|
02120AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
211
|
| 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
|
|
|
02120AW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
212
|
| 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
|
|
|
02120J3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
213
|
| 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
|
|
|
02120J8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
214
|
| 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
|
|
|
02120J9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
215
|
| 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
|
|
|
02120JC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
216
|
| 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
|
|
|
02120JF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
217
|
| 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
|
|
|
02120JW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
218
|
| 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
|
|
|
02120K3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
219
|
| 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
|
|
|
02120K8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
220
|
| 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
|
|
|
02120K9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
221
|
| 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
|
|
|
02120KC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
222
|
| 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
|
|
|
02120KF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
223
|
| 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
|
|
|
02120KW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
224
|
| 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
|
|
|
02120Z3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
225
|
| 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
|
|
|
02120Z8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
226
|
| 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
|
|
|
02120Z9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
227
|
| 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
|
|
|
02120ZC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
228
|
| 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
|
|
|
02120ZF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2867
|
| 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
|
|
|
0212344
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2868
|
| 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
|
|
|
02123D4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
229
|
| 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
|
|
|
0212444
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
230
|
| 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
|
|
|
0212483
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
231
|
| 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
|
|
|
0212488
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
232
|
| 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
|
|
|
0212489
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
233
|
| 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
|
|
