|
021V48S
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
479
|
| 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
|
|
|
021V48T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
480
|
| 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
|
|
|
021V48U
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
481
|
| 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
|
|
|
021V49S
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
482
|
| 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
|
|
|
021V49T
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
483
|
| 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
|
|
|
021V49U
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
484
|
| 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
|
|
|
021V4AS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
485
|
| 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
|
|
|
021V4AT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
486
|
| 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
|
|
|
021V4AU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
487
|
| 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
|
|
|
021V4JS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
488
|
| 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
|
|
|
021V4JT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
489
|
| 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
|
|
|
021V4JU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
490
|
| 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
|
|
|
021V4KS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
491
|
| 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
|
|
|
021V4KT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
492
|
| 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
|
|
|
021V4KU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
493
|
| 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
|
|
|
021V4ZS
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
494
|
| 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
|
|
|
021V4ZT
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
495
|
| 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
|
|
|
021V4ZU
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
496
|
| 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
|
|
|
021W08A
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
497
|
| 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
|
|
|
021W08P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
498
|
| 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
|
|
|
021W09A
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
499
|
| 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
|
|
|
021W09P
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
500
|
| 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
|
|
|
021W0AA
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
501
|
| 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
|
|
|
021W0AP
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
502
|
| 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
|
|
|
021W0JA
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
503
|
| 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
|
|
