|
02100A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
84
|
| 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
|
|
|
02100AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
85
|
| 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
|
|
|
02100AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
86
|
| 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
|
|
|
02100AW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2844
|
| 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
|
|
|
02100J3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
87
|
| 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
|
|
|
02100J8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
88
|
| 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
|
|
|
02100J9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
89
|
| 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
|
|
|
02100JC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
90
|
| 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
|
|
|
02100JF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
91
|
| 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
|
|
|
02100JW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2845
|
| 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
|
|
|
02100K3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
92
|
| 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
|
|
|
02100K8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
93
|
| 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
|
|
|
02100K9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
94
|
| 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
|
|
|
02100KC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
95
|
| 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
|
|
|
02100KF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
96
|
| 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
|
|
|
02100KW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2846
|
| 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
|
|
|
02100Z3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
97
|
| 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
|
|
|
02100Z8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
98
|
| 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
|
|
|
02100Z9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
99
|
| 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
|
|
|
02100ZC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
100
|
| 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
|
|
|
02100ZF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
101
|
| 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
|
|
|
0210344
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2847
|
| 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
|
|
|
02103D4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
102
|
| 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
|
|
|
0210444
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
103
|
| 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
|
|
|
0210483
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
104
|
| 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
|
|
