|
021K0ZR
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
429
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K0ZW
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
430
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K48P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
431
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K48Q
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
432
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K48R
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
433
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K49P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
434
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K4Z5
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
435
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K4Z8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
436
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K4ZC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
437
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K4ZP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
438
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021K4ZW
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
439
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L08P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
440
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L08Q
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
441
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L08R
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
442
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L0AP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
443
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L0Z5
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
444
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L0Z8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
445
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L0ZW
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
446
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L48P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
447
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L48Q
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
448
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L48R
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
449
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L4Z5
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
450
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L4Z8
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
451
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021L4ZW
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
452
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021P0AA
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
453
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
