Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0011
Hospital Revenue Code	136
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0009
Hospital Revenue Code	116
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0009
Hospital Revenue Code	146
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0009
Hospital Revenue Code	156
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0011
Hospital Revenue Code	116
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0011
Hospital Revenue Code	146
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0008
Hospital Revenue Code	156
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0010
Hospital Revenue Code	156
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0010
Hospital Revenue Code	116
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0009
Hospital Revenue Code	136
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0009
Hospital Revenue Code	126
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0008
Hospital Revenue Code	126
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0008
Hospital Revenue Code	116
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0010
Hospital Revenue Code	126
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0010
Hospital Revenue Code	146
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0008
Hospital Revenue Code	146
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0011
Hospital Revenue Code	126
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0008
Hospital Revenue Code	136
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

Inpatient Detox - Must be billed with HCPCS H0008-H0011 in addition to 1X6 rev code

Facility

IP

$1,112.00

Service Code	HCPCS H0011
Hospital Revenue Code	156
Min. Negotiated Rate	$1,112.00
Max. Negotiated Rate	$1,112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,112.00

INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [114723]

Facility

IP

$8.68

Service Code	NDC 0169-3685-12
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$6.94
Rate for Payer: Cash Price	$4.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.94
Rate for Payer: Health Smart Auto/Commercial	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$4.77
Rate for Payer: Multiplan Commercial	$6.51

INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [114723]

Facility

OP

$8.68

Service Code	NDC 0169-3685-12
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$6.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.21
Rate for Payer: Aetna of CA Government/Medicare	$5.21
Rate for Payer: Cash Price	$4.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.94
Rate for Payer: Health Smart Auto/Commercial	$5.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$4.77
Rate for Payer: Multiplan Commercial	$6.51

INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [28534]

Facility

IP

$8.68

Service Code	NDC 0169-7501-11
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$6.94
Rate for Payer: Cash Price	$4.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.94
Rate for Payer: Health Smart Auto/Commercial	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$4.77
Rate for Payer: Multiplan Commercial	$6.51

INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [28534]

Facility

OP

$8.68

Service Code	NDC 0169-7501-11
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$6.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.21
Rate for Payer: Aetna of CA Government/Medicare	$5.21
Rate for Payer: Cash Price	$4.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.94
Rate for Payer: Health Smart Auto/Commercial	$5.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$4.77
Rate for Payer: Multiplan Commercial	$6.51

INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]

Facility

IP

$40.67

Service Code	HCPCS J1815
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$32.54
Rate for Payer: Cash Price	$22.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.54
Rate for Payer: Health Smart Auto/Commercial	$24.40
Rate for Payer: LLUH Dept of Risk Management WC	$22.37
Rate for Payer: Multiplan Commercial	$30.50

INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]

Facility

OP

$40.67

Service Code	HCPCS J1815
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$32.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.40
Rate for Payer: Aetna of CA Government/Medicare	$24.40
Rate for Payer: Cash Price	$22.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.54
Rate for Payer: Health Smart Auto/Commercial	$24.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.40
Rate for Payer: LLUH Dept of Risk Management WC	$22.37
Rate for Payer: Multiplan Commercial	$30.50

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