|
0210488
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
105
|
| 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
|
|
|
0210489
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
106
|
| 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
|
|
|
021048C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
107
|
| 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
|
|
|
021048F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
108
|
| 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
|
|
|
021048W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
109
|
| 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
|
|
|
0210493
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
110
|
| 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
|
|
|
0210498
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2848
|
| 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
|
|
|
0210499
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2849
|
| 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
|
|
|
021049C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
111
|
| 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
|
|
|
021049F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
112
|
| 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
|
|
|
021049W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2850
|
| 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
|
|
|
02104A3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
113
|
| 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
|
|
|
02104A8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
114
|
| 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
|
|
|
02104A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2851
|
| 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
|
|
|
02104AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
115
|
| 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
|
|
|
02104AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
116
|
| 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
|
|
|
02104AW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2852
|
| 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
|
|
|
02104D4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
117
|
| 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
|
|
|
02104J3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
118
|
| 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
|
|
|
02104J8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
119
|
| 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
|
|
|
02104J9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
120
|
| 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
|
|
|
02104JC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
121
|
| 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
|
|
|
02104JF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
122
|
| 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
|
|
|
02104JW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2853
|
| 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
|
|
|
02104K3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
123
|
| 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
|
|
