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Service Code NDC 0065-8064-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.47
Max. Negotiated Rate $0.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.52
Rate for Payer: Aetna of CA Government/Medicare $0.52
Rate for Payer: Cash Price $0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.69
Rate for Payer: Health Smart Auto/Commercial $0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.52
Rate for Payer: LLUH Dept of Risk Management WC $0.47
Rate for Payer: Multiplan Commercial $0.65
Service Code NDC 0065-8064-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.47
Max. Negotiated Rate $0.69
Rate for Payer: Cash Price $0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.69
Rate for Payer: Health Smart Auto/Commercial $0.52
Rate for Payer: LLUH Dept of Risk Management WC $0.47
Rate for Payer: Multiplan Commercial $0.65
Service Code NDC 0078-1091-20
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $246.01
Max. Negotiated Rate $357.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $268.38
Rate for Payer: Aetna of CA Government/Medicare $268.38
Rate for Payer: Cash Price $246.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $357.84
Rate for Payer: Health Smart Auto/Commercial $268.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $268.38
Rate for Payer: LLUH Dept of Risk Management WC $246.01
Rate for Payer: Multiplan Commercial $335.48
Service Code NDC 0078-1091-20
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $246.01
Max. Negotiated Rate $357.84
Rate for Payer: Cash Price $246.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $357.84
Rate for Payer: Health Smart Auto/Commercial $268.38
Rate for Payer: LLUH Dept of Risk Management WC $246.01
Rate for Payer: Multiplan Commercial $335.48
Service Code NDC 0078-1098-20
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $246.01
Max. Negotiated Rate $357.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $268.38
Rate for Payer: Aetna of CA Government/Medicare $268.38
Rate for Payer: Cash Price $246.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $357.84
Rate for Payer: Health Smart Auto/Commercial $268.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $268.38
Rate for Payer: LLUH Dept of Risk Management WC $246.01
Rate for Payer: Multiplan Commercial $335.48
Service Code NDC 0078-1098-20
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $246.01
Max. Negotiated Rate $357.84
Rate for Payer: Cash Price $246.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $357.84
Rate for Payer: Health Smart Auto/Commercial $268.38
Rate for Payer: LLUH Dept of Risk Management WC $246.01
Rate for Payer: Multiplan Commercial $335.48
Service Code NDC 6961801854
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.05
Rate for Payer: Cash Price $0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.05
Rate for Payer: Health Smart Auto/Commercial $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.05
Service Code NDC 6961801854
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.04
Rate for Payer: Aetna of CA Government/Medicare $0.04
Rate for Payer: Cash Price $0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.05
Rate for Payer: Health Smart Auto/Commercial $0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.05
Service Code NDC 5789684216
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 5789684216
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.02
Rate for Payer: Aetna of CA Government/Medicare $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 67457-118-50
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $1.19
Max. Negotiated Rate $1.74
Rate for Payer: Cash Price $1.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.74
Rate for Payer: Health Smart Auto/Commercial $1.30
Rate for Payer: LLUH Dept of Risk Management WC $1.19
Rate for Payer: Multiplan Commercial $1.63
Service Code NDC 67457-118-50
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $1.19
Max. Negotiated Rate $1.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.30
Rate for Payer: Aetna of CA Government/Medicare $1.30
Rate for Payer: Cash Price $1.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.74
Rate for Payer: Health Smart Auto/Commercial $1.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.30
Rate for Payer: LLUH Dept of Risk Management WC $1.19
Rate for Payer: Multiplan Commercial $1.63
Service Code NDC 67157-101-51
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $3.53
Max. Negotiated Rate $5.14
Rate for Payer: Cash Price $3.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $5.14
Rate for Payer: Health Smart Auto/Commercial $3.85
Rate for Payer: LLUH Dept of Risk Management WC $3.53
Rate for Payer: Multiplan Commercial $4.82
Service Code NDC 67157-101-50
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $3.57
Max. Negotiated Rate $5.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $3.89
Rate for Payer: Aetna of CA Government/Medicare $3.89
Rate for Payer: Cash Price $3.57
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $5.19
Rate for Payer: Health Smart Auto/Commercial $3.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $3.89
Rate for Payer: LLUH Dept of Risk Management WC $3.57
Rate for Payer: Multiplan Commercial $4.87
Service Code NDC 67157-101-50
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $3.57
Max. Negotiated Rate $5.19
Rate for Payer: Cash Price $3.57
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $5.19
Rate for Payer: Health Smart Auto/Commercial $3.89
Rate for Payer: LLUH Dept of Risk Management WC $3.57
Rate for Payer: Multiplan Commercial $4.87
Service Code NDC 67157-101-51
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $3.53
Max. Negotiated Rate $5.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $3.85
Rate for Payer: Aetna of CA Government/Medicare $3.85
Rate for Payer: Cash Price $3.53
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $5.14
Rate for Payer: Health Smart Auto/Commercial $3.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $3.85
Rate for Payer: LLUH Dept of Risk Management WC $3.53
Rate for Payer: Multiplan Commercial $4.82
Service Code NDC 0904052360
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.02
Rate for Payer: Aetna of CA Government/Medicare $0.02
Rate for Payer: Cash Price $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 5789684101
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.02
Rate for Payer: Aetna of CA Government/Medicare $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 0904052372
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.02
Rate for Payer: Cash Price $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 8770140741
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.02
Rate for Payer: Aetna of CA Government/Medicare $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 8770140741
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 0904052361
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.03
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.03
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.03
Service Code NDC 8770140739
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.02
Rate for Payer: Aetna of CA Government/Medicare $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.03
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.03
Service Code NDC 0904052360
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Cash Price $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 5789684101
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.02