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Service Code NDC 0713-0280-31
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.05
Rate for Payer: Aetna of CA Government/Medicare $0.05
Rate for Payer: Cash Price $0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.07
Rate for Payer: Health Smart Auto/Commercial $0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Multiplan Commercial $0.07
Service Code NDC 45802-060-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.12
Rate for Payer: Cash Price $0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.12
Rate for Payer: Health Smart Auto/Commercial $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.11
Service Code NDC 68001-477-47
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.05
Rate for Payer: Aetna of CA Government/Medicare $0.05
Rate for Payer: Cash Price $0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.07
Rate for Payer: Health Smart Auto/Commercial $0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Multiplan Commercial $0.07
Service Code NDC 0536-1256-28
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.06
Rate for Payer: Cash Price $0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.06
Rate for Payer: Health Smart Auto/Commercial $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.04
Rate for Payer: Multiplan Commercial $0.06
Service Code NDC 45802-060-03
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.06
Rate for Payer: Aetna of CA Government/Medicare $0.06
Rate for Payer: Cash Price $0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.08
Rate for Payer: Health Smart Auto/Commercial $0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.06
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.08
Service Code NDC 45802-060-00
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 45802-060-70
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 68001-477-48
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 45802-060-70
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.10
Rate for Payer: Aetna of CA Government/Medicare $0.10
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 68001-477-45
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.10
Rate for Payer: Aetna of CA Government/Medicare $0.10
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 68001-477-48
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.10
Rate for Payer: Aetna of CA Government/Medicare $0.10
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 45802-060-00
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.10
Rate for Payer: Aetna of CA Government/Medicare $0.10
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 68001-477-45
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.13
Rate for Payer: Cash Price $0.09
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.13
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 24208-555-55
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $4.32
Max. Negotiated Rate $6.29
Rate for Payer: Cash Price $4.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $6.29
Rate for Payer: Health Smart Auto/Commercial $4.72
Rate for Payer: LLUH Dept of Risk Management WC $4.32
Rate for Payer: Multiplan Commercial $5.89
Service Code NDC 24208-555-55
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $4.32
Max. Negotiated Rate $6.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $4.72
Rate for Payer: Aetna of CA Government/Medicare $4.72
Rate for Payer: Cash Price $4.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $6.29
Rate for Payer: Health Smart Auto/Commercial $4.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $4.72
Rate for Payer: LLUH Dept of Risk Management WC $4.32
Rate for Payer: Multiplan Commercial $5.89
Service Code NDC 51672-2075-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.16
Rate for Payer: Aetna of CA Government/Medicare $0.16
Rate for Payer: Cash Price $0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.22
Rate for Payer: Health Smart Auto/Commercial $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.20
Service Code NDC 51672-2075-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.22
Rate for Payer: Cash Price $0.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.22
Rate for Payer: Health Smart Auto/Commercial $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.20
Service Code NDC 69968-060-03
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.19
Rate for Payer: Aetna of CA Government/Medicare $0.19
Rate for Payer: Cash Price $0.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.25
Rate for Payer: Health Smart Auto/Commercial $0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.19
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 58980-012-05
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.24
Rate for Payer: Cash Price $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.24
Rate for Payer: Health Smart Auto/Commercial $0.18
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 51672-2044-2
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.14
Rate for Payer: Aetna of CA Government/Medicare $0.14
Rate for Payer: Cash Price $0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.18
Rate for Payer: Health Smart Auto/Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.14
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.17
Service Code NDC 0081079888
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.34
Rate for Payer: Cash Price $0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.34
Rate for Payer: Health Smart Auto/Commercial $0.25
Rate for Payer: LLUH Dept of Risk Management WC $0.23
Rate for Payer: Multiplan Commercial $0.32
Service Code NDC 69968-060-03
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.25
Rate for Payer: Cash Price $0.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.25
Rate for Payer: Health Smart Auto/Commercial $0.19
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 0081079888
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.25
Rate for Payer: Aetna of CA Government/Medicare $0.25
Rate for Payer: Cash Price $0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.34
Rate for Payer: Health Smart Auto/Commercial $0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.25
Rate for Payer: LLUH Dept of Risk Management WC $0.23
Rate for Payer: Multiplan Commercial $0.32
Service Code NDC 58980-012-05
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.18
Rate for Payer: Aetna of CA Government/Medicare $0.18
Rate for Payer: Cash Price $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.24
Rate for Payer: Health Smart Auto/Commercial $0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.18
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 51672-2044-2
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.18
Rate for Payer: Cash Price $0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.18
Rate for Payer: Health Smart Auto/Commercial $0.14
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.17