|
02174AU
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
399
|
| 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
|
|
|
02174JP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2904
|
| 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
|
|
|
02174JQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2905
|
| 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
|
|
|
02174JR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2906
|
| 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
|
|
|
02174JS
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
400
|
| 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
|
|
|
02174JT
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
401
|
| 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
|
|
|
02174JU
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
402
|
| 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
|
|
|
02174KP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2907
|
| 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
|
|
|
02174KQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2908
|
| 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
|
|
|
02174KR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2909
|
| 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
|
|
|
02174KS
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
403
|
| 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
|
|
|
02174KT
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
404
|
| 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
|
|
|
02174KU
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
405
|
| 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
|
|
|
02174ZP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2910
|
| 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
|
|
|
02174ZQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2911
|
| 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
|
|
|
02174ZR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2912
|
| 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
|
|
|
02174ZS
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
406
|
| 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
|
|
|
02174ZT
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
407
|
| 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
|
|
|
02174ZU
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
408
|
| 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
|
|
|
021K08P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
409
|
| 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
|
|
|
021K08Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
410
|
| 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
|
|
|
021K08R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
411
|
| 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
|
|
|
021K09P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
412
|
| 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
|
|
|
021K09Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
413
|
| 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
|
|
|
021K09R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
414
|
| 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
|
|
