|
02104K8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
124
|
| 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
|
|
|
02104K9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
125
|
| 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
|
|
|
02104KC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
126
|
| 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
|
|
|
02104KF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
127
|
| 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
|
|
|
02104KW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2854
|
| 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
|
|
|
02104Z3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
128
|
| 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
|
|
|
02104Z8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2855
|
| 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
|
|
|
02104Z9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2856
|
| 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
|
|
|
02104ZC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2857
|
| 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
|
|
|
02104ZF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
129
|
| 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
|
|
|
0211083
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
130
|
| 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
|
|
|
0211088
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
131
|
| 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
|
|
|
0211089
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
132
|
| 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
|
|
|
021108C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
133
|
| 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
|
|
|
021108F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
134
|
| 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
|
|
|
021108W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
135
|
| 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
|
|
|
0211093
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
136
|
| 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
|
|
|
0211098
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
137
|
| 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
|
|
|
0211099
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
138
|
| 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
|
|
|
021109C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
139
|
| 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
|
|
|
021109F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
140
|
| 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
|
|
|
021109W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2858
|
| 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
|
|
|
02110A3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
141
|
| 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
|
|
|
02110A8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
142
|
| 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
|
|
|
02110A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
143
|
| 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
|
|
