|
021708T
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
352
|
| 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
|
|
|
021708U
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
353
|
| 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
|
|
|
021709P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
354
|
| 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
|
|
|
021709Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
355
|
| 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
|
|
|
021709R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
356
|
| 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
|
|
|
021709S
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
357
|
| 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
|
|
|
021709T
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
358
|
| 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
|
|
|
021709U
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
359
|
| 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
|
|
|
02170AP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
360
|
| 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
|
|
|
02170AQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
361
|
| 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
|
|
|
02170AR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
362
|
| 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
|
|
|
02170AS
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
363
|
| 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
|
|
|
02170AT
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
364
|
| 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
|
|
|
02170AU
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
365
|
| 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
|
|
|
02170JP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
366
|
| 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
|
|
|
02170JQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
367
|
| 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
|
|
|
02170JR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
368
|
| 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
|
|
|
02170JS
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
369
|
| 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
|
|
|
02170JT
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
370
|
| 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
|
|
|
02170JU
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
371
|
| 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
|
|
|
02170KP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
372
|
| 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
|
|
|
02170KQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
373
|
| 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
|
|
|
02170KR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
374
|
| 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
|
|
|
02170KS
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
375
|
| 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
|
|
|
02170KT
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
376
|
| 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
|
|
