|
02110AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
144
|
| 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
|
|
|
02110AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
145
|
| 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
|
|
|
02110AW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2859
|
| 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
|
|
|
02110J3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
146
|
| 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
|
|
|
02110J8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
147
|
| 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
|
|
|
02110J9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
148
|
| 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
|
|
|
02110JC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
149
|
| 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
|
|
|
02110JF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
150
|
| 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
|
|
|
02110JW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2860
|
| 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
|
|
|
02110K3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
151
|
| 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
|
|
|
02110K8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
152
|
| 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
|
|
|
02110K9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
153
|
| 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
|
|
|
02110KC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
154
|
| 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
|
|
|
02110KF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
155
|
| 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
|
|
|
02110KW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2861
|
| 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
|
|
|
02110Z3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
156
|
| 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
|
|
|
02110Z8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
157
|
| 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
|
|
|
02110Z9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
158
|
| 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
|
|
|
02110ZC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
159
|
| 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
|
|
|
02110ZF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
160
|
| 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
|
|
|
0211344
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2862
|
| 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
|
|
|
02113D4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
161
|
| 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
|
|
|
0211444
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
162
|
| 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
|
|
|
0211483
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
163
|
| 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
|
|
|
0211488
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
164
|
| 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
|
|
