|
021348F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
293
|
| 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
|
|
|
021348W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
294
|
| 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
|
|
|
0213493
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
295
|
| 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
|
|
|
0213498
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
296
|
| 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
|
|
|
0213499
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2885
|
| 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
|
|
|
021349C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
297
|
| 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
|
|
|
021349F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2886
|
| 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
|
|
|
021349W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2887
|
| 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
|
|
|
02134A3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
298
|
| 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
|
|
|
02134A8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
299
|
| 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
|
|
|
02134A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2888
|
| 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
|
|
|
02134AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
300
|
| 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
|
|
|
02134AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2889
|
| 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
|
|
|
02134AW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2890
|
| 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
|
|
|
02134D4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
301
|
| 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
|
|
|
02134J3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
302
|
| 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
|
|
|
02134J8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
303
|
| 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
|
|
|
02134J9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2891
|
| 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
|
|
|
02134JC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
304
|
| 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
|
|
|
02134JF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2892
|
| 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
|
|
|
02134JW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2893
|
| 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
|
|
|
02134K3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
305
|
| 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
|
|
|
02134K8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
306
|
| 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
|
|
|
02134K9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2894
|
| 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
|
|
|
02134KC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2895
|
| 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
|
|
