|
021W4JQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3012
|
| 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
|
|
|
021W4JR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3013
|
| 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
|
|
|
021W4KA
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
517
|
| 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
|
|
|
021W4KP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
518
|
| 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
|
|
|
021W4KQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3014
|
| 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
|
|
|
021W4KR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3015
|
| 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
|
|
|
021W4ZA
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
519
|
| 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
|
|
|
021W4ZP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
520
|
| 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
|
|
|
021W4ZQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3016
|
| 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
|
|
|
021W4ZR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3017
|
| 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
|
|
|
021X08A
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
521
|
| 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
|
|
|
021X08P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
522
|
| 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
|
|
|
021X08Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3018
|
| 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
|
|
|
021X08R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3019
|
| 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
|
|
|
021X09A
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
523
|
| 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
|
|
|
021X09P
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
524
|
| 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
|
|
|
021X09Q
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3020
|
| 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
|
|
|
021X09R
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3021
|
| 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
|
|
|
021X0AA
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
525
|
| 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
|
|
|
021X0AP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
526
|
| 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
|
|
|
021X0AQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3022
|
| 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
|
|
|
021X0AR
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3023
|
| 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
|
|
|
021X0JA
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
527
|
| 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
|
|
|
021X0JP
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
528
|
| 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
|
|
|
021X0JQ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
3024
|
| 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
|
|
