|
0D160J9
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4901
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D160JA
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4902
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D160K9
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4903
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D160KA
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4904
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D160Z9
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4905
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D160ZA
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4906
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D16479
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4907
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D1647A
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4908
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D164J9
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4909
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D164JA
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4910
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D164K9
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4911
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D164KA
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4912
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D164Z9
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4913
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0D164ZA
|
Facility
|
IP
|
$12,050.00
|
|
| Hospital Charge Code |
4914
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
|
|
0DH501Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4915
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH531Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4916
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH541Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4917
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH571Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4918
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH581Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4919
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH601Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4920
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH60MZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2525
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0DH631Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4921
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH63MZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2526
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
0DH641Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
4922
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0DH64MZ
|
Facility
|
IP
|
$29,594.00
|
|
| Hospital Charge Code |
2527
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
