|
021V08P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
454
|
| 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
|
|
|
021V08Q
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
455
|
| 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
|
|
|
021V08R
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
456
|
| 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
|
|
|
021V08S
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
457
|
| 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
|
|
|
021V08T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
458
|
| 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
|
|
|
021V08U
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
459
|
| 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
|
|
|
021V09S
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
460
|
| 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
|
|
|
021V09T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
461
|
| 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
|
|
|
021V09U
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
462
|
| 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
|
|
|
021V0AP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
463
|
| 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
|
|
|
021V0AS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
464
|
| 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
|
|
|
021V0AT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
465
|
| 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
|
|
|
021V0AU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
466
|
| 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
|
|
|
021V0JS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
467
|
| 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
|
|
|
021V0JT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
468
|
| 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
|
|
|
021V0JU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
469
|
| 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
|
|
|
021V0KS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
470
|
| 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
|
|
|
021V0KT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
471
|
| 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
|
|
|
021V0KU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
472
|
| 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
|
|
|
021V0ZS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
473
|
| 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
|
|
|
021V0ZT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
474
|
| 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
|
|
|
021V0ZU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
475
|
| 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
|
|
|
021V48P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
476
|
| 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
|
|
|
021V48Q
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
477
|
| 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
|
|
|
021V48R
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
478
|
| 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
|
|
