|
02114K9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
187
|
| 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
|
|
|
02114KC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
188
|
| 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
|
|
|
02114KF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
189
|
| 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
|
|
|
02114KW
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2866
|
| 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
|
|
|
02114Z3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
190
|
| 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
|
|
|
02114Z8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
191
|
| 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
|
|
|
02114Z9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
192
|
| 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
|
|
|
02114ZC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
193
|
| 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
|
|
|
02114ZF
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
194
|
| 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
|
|
|
0212083
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
195
|
| 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
|
|
|
0212088
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
196
|
| 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
|
|
|
0212089
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
197
|
| 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
|
|
|
021208C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
198
|
| 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
|
|
|
021208F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
199
|
| 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
|
|
|
021208W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
200
|
| 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
|
|
|
0212093
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
201
|
| 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
|
|
|
0212098
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
202
|
| 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
|
|
|
0212099
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
203
|
| 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
|
|
|
021209C
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
204
|
| 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
|
|
|
021209F
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
205
|
| 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
|
|
|
021209W
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
206
|
| 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
|
|
|
02120A3
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
207
|
| 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
|
|
|
02120A8
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
208
|
| 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
|
|
|
02120A9
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
209
|
| 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
|
|
|
02120AC
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
210
|
| 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
|
|
