Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.50

Service Code	NDC 67457-385-10
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$2.23

Service Code	NDC 0409-2720-01
Hospital Charge Code	1720392
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cigna of CA HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.67

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.50

Service Code	NDC 67457-385-10
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.30
Rate for Payer: Aetna of CA Government/Medicare	$0.30
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$0.41

Service Code	NDC 0069-0058-01
Hospital Charge Code	1720069
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.31
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	$0.18
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 Beech St/Commercial/PHCS	$0.31

HEPARIN (PORCINE) 20,000 UNIT/ML INJECTION SOLUTION [10178]

Facility

$12.00

Service Code	CPT J1644
Hospital Charge Code	NDG10178
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HEPARIN (PORCINE) 20,000 UNIT/ML INJECTION SOLUTION [10178]

Facility

$12.00

Service Code	CPT J1644
Hospital Charge Code	NDG10178
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN D5W (RAD) [40815846]

Facility

$0.04

Service Code	CPT J1644
Hospital Charge Code	1771181
Hospital Revenue Code	636
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 EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN D5W (RAD) [40815846]

Facility

$0.04

Service Code	CPT J1644
Hospital Charge Code	1771181
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [15846]

Facility

$2.40

Service Code	CPT J1644
Hospital Charge Code	1771181
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.92
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$1.92
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [15846]

Facility

$0.04

Service Code	CPT J1644
Hospital Charge Code	1771181
Hospital Revenue Code	636
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 EPO/HMO/POS/PPO	$1.44
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: Aetna of CA Government/Medicare	$1.44
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.80

HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]

Facility

$0.04

Service Code	CPT J1644
Hospital Charge Code	NDG15849
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.03

HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]

Facility

$0.04

Service Code	CPT J1644
Hospital Charge Code	NDG15849
Hospital Revenue Code	636
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: 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 Beech St/Commercial/PHCS	$0.03

HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]

Facility

$1.52

Service Code	CPT J1644
Hospital Charge Code	NDG10181
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.22
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of CA HMO/PPO	$1.22
Rate for Payer: Cigna of CA HMO/PPO	$0.81
Rate for Payer: Health Smart Auto/Commercial	$0.91
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.76

HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]

Facility

$1.01

Service Code	CPT J1644
Hospital Charge Code	NDG10181
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.61
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.91
Rate for Payer: Aetna of CA Government/Medicare	$0.91
Rate for Payer: Aetna of CA Government/Medicare	$0.61
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cash Price	$0.45
Rate for Payer: Health Smart Auto/Commercial	$0.91
Rate for Payer: Health Smart Auto/Commercial	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.91
Rate for Payer: LLUH Dept of Risk Management WC	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.14

HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]

Facility

$2.28

Service Code	CPT J1644
Hospital Charge Code	1721146
Hospital Revenue Code	636
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.82
Rate for Payer: Cash Price	$1.03
Rate for Payer: Cash Price	$1.09
Rate for Payer: Cash Price	$1.39
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cigna of CA HMO/PPO	$1.44
Rate for Payer: Cigna of CA HMO/PPO	$1.82
Rate for Payer: Cigna of CA HMO/PPO	$2.50
Rate for Payer: Cigna of CA HMO/PPO	$2.46
Rate for Payer: Cigna of CA HMO/PPO	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.85
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Health Smart Auto/Commercial	$1.45
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.31

HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]

Facility

$2.42

Service Code	CPT J1644
Hospital Charge Code	1721146
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.37
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.87
Rate for Payer: Aetna of CA Government/Medicare	$1.85
Rate for Payer: Aetna of CA Government/Medicare	$1.45
Rate for Payer: Aetna of CA Government/Medicare	$1.37
Rate for Payer: Cash Price	$1.03
Rate for Payer: Cash Price	$1.09
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cash Price	$1.39
Rate for Payer: Health Smart Auto/Commercial	$1.85
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Health Smart Auto/Commercial	$1.87
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Health Smart Auto/Commercial	$1.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: LLUH Dept of Risk Management WC	$1.33
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.31

HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [15847]

Facility

$0.01

Service Code	CPT J1644
Hospital Charge Code	1771169
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [15847]

Facility

$0.01

Service Code	CPT J1644
Hospital Charge Code	1771169
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

$0.24

Service Code	NDC 6380760005
Hospital Charge Code	1720019
Hospital Revenue Code	272
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	$0.11
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 Beech St/Commercial/PHCS	$0.18

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

$0.17

Service Code	NDC 8290306424
Hospital Charge Code	1720019
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

$0.24

Service Code	NDC 6380760005
Hospital Charge Code	1720019
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.18

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]

Facility

$0.17

Service Code	NDC 8290306424
Hospital Charge Code	1720019
Hospital Revenue Code	272
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	$0.08
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 Beech St/Commercial/PHCS	$0.13

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]

Facility

$9.60

Service Code	CPT J1644
Hospital Charge Code	NDG121687
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$7.68
Rate for Payer: Cash Price	$4.32
Rate for Payer: Cigna of CA HMO/PPO	$7.68
Rate for Payer: Health Smart Auto/Commercial	$5.76
Rate for Payer: LLUH Dept of Risk Management WC	$5.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.20

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]

Facility

$9.60

Service Code	CPT J1644
Hospital Charge Code	NDG121687
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.76
Rate for Payer: Aetna of CA Government/Medicare	$5.76
Rate for Payer: Cash Price	$4.32
Rate for Payer: Health Smart Auto/Commercial	$5.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.76
Rate for Payer: LLUH Dept of Risk Management WC	$5.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.20

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE [117969]

Facility

$7.96

Service Code	CPT J1644
Hospital Charge Code	1720049
Hospital Revenue Code	636
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$5.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.78
Rate for Payer: Aetna of CA Government/Medicare	$4.78
Rate for Payer: Cash Price	$3.58
Rate for Payer: Health Smart Auto/Commercial	$4.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.78
Rate for Payer: LLUH Dept of Risk Management WC	$4.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.97

Know your out-of-pocket cost for care.

All Charges