| 02WA0YZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1505 |  
                                            | 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 |  | 
            
                
                    | 02WA32Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1506 |  
                                            | 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 |  | 
            
                
                    | 02WA33Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3521 |  
                                            | 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 |  | 
            
                
                    | 02WA37Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3522 |  
                                            | 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 |  | 
            
                
                    | 02WA38Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3523 |  
                                            | 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 |  | 
            
                
                    | 02WA3CZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3524 |  
                                            | 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 |  | 
            
                
                    | 02WA3DZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3525 |  
                                            | 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 |  | 
            
                
                    | 02WA3JZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3526 |  
                                            | 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 |  | 
            
                
                    | 02WA3KZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3527 |  
                                            | 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 |  | 
            
                
                    | 02WA3QZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1508 |  
                                            | 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 |  | 
            
                
                    | 02WA3QZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1509 |  
                                            | 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 |  | 
            
                
                    | 02WA3RS | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1511 |  
                                            | 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 |  | 
            
                
                    | 02WA3RS | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1510 |  
                                            | 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 |  | 
            
                
                    | 02WA3YZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1513 |  
                                            | 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 |  | 
            
                
                    | 02WA42Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1514 |  
                                            | 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 |  | 
            
                
                    | 02WA43Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3528 |  
                                            | 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 |  | 
            
                
                    | 02WA47Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3529 |  
                                            | 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 |  | 
            
                
                    | 02WA48Z | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3530 |  
                                            | 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 |  | 
            
                
                    | 02WA4CZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3531 |  
                                            | 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 |  | 
            
                
                    | 02WA4DZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3532 |  
                                            | 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 |  | 
            
                
                    | 02WA4JZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3533 |  
                                            | 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 |  | 
            
                
                    | 02WA4KZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 3534 |  
                                            | 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 |  | 
            
                
                    | 02WA4QZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1516 |  
                                            | 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 |  | 
            
                
                    | 02WA4QZ | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1517 |  
                                            | 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 |  | 
            
                
                    | 02WA4RS | Facility | IP | $10,777.00 |  | 
                
                    | 
                            
                                
                                    
                                    
                                    
                                        | Hospital Charge Code | 1519 |  
                                            | 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 |  |