|
0211489
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
165
|
| 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
|
|
|
021148C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
166
|
| 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
|
|
|
021148F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
167
|
| 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
|
|
|
021148W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
168
|
| 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
|
|
|
0211493
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
169
|
| 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
|
|
|
0211498
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
170
|
| 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
|
|
|
0211499
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
171
|
| 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
|
|
|
021149C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
172
|
| 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
|
|
|
021149F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
173
|
| 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
|
|
|
021149W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2863
|
| 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
|
|
|
02114A3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
174
|
| 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
|
|
|
02114A8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
175
|
| 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
|
|
|
02114A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
176
|
| 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
|
|
|
02114AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
177
|
| 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
|
|
|
02114AF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
178
|
| 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
|
|
|
02114AW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2864
|
| 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
|
|
|
02114D4
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
179
|
| 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
|
|
|
02114J3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
180
|
| 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
|
|
|
02114J8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
181
|
| 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
|
|
|
02114J9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
182
|
| 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
|
|
|
02114JC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
183
|
| 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
|
|
|
02114JF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
184
|
| 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
|
|
|
02114JW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2865
|
| 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
|
|
|
02114K3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
185
|
| 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
|
|
|
02114K8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
186
|
| 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
|
|
