|
0FH401Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FH401Z
|
| Hospital Charge Code |
4958
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FH431Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FH431Z
|
| Hospital Charge Code |
4959
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FH441Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FH441Z
|
| Hospital Charge Code |
4960
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHB01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHB01Z
|
| Hospital Charge Code |
4961
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHB31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHB31Z
|
| Hospital Charge Code |
4962
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHB41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHB41Z
|
| Hospital Charge Code |
4963
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHB71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHB71Z
|
| Hospital Charge Code |
4964
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHB81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHB81Z
|
| Hospital Charge Code |
4965
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHD01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHD01Z
|
| Hospital Charge Code |
4966
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHD31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHD31Z
|
| Hospital Charge Code |
4967
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHD41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHD41Z
|
| Hospital Charge Code |
4968
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHD71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHD71Z
|
| Hospital Charge Code |
4969
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHD81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHD81Z
|
| Hospital Charge Code |
4970
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHG01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHG01Z
|
| Hospital Charge Code |
4971
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHG31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHG31Z
|
| Hospital Charge Code |
4972
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0FHG41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FHG41Z
|
| Hospital Charge Code |
4973
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0GHS01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0GHS01Z
|
| Hospital Charge Code |
4974
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0GHS31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0GHS31Z
|
| Hospital Charge Code |
4975
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0GHS41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0GHS41Z
|
| Hospital Charge Code |
4976
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0HHT01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHT01Z
|
| Hospital Charge Code |
4977
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0HHT31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHT31Z
|
| Hospital Charge Code |
4978
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0HHT71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHT71Z
|
| Hospital Charge Code |
4979
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0HHTX1Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHTX1Z
|
| Hospital Charge Code |
4980
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0HHU01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHU01Z
|
| Hospital Charge Code |
4981
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0HHU31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHU31Z
|
| Hospital Charge Code |
4982
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
