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Service Code NDC 50742-616-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.10
Rate for Payer: Cash Price $0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.10
Rate for Payer: Health Smart Auto/Commercial $0.08
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Multiplan Commercial $0.10
Service Code NDC 67877-591-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.06
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 $0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.06
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 $0.04
Rate for Payer: Multiplan Commercial $0.05
Service Code NDC 68382-565-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.14
Rate for Payer: Cash Price $0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.14
Rate for Payer: Health Smart Auto/Commercial $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.10
Rate for Payer: Multiplan Commercial $0.14
Service Code NDC 60687-402-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.64
Max. Negotiated Rate $0.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.70
Rate for Payer: Aetna of CA Government/Medicare $0.70
Rate for Payer: Cash Price $0.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.94
Rate for Payer: Health Smart Auto/Commercial $0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.70
Rate for Payer: LLUH Dept of Risk Management WC $0.64
Rate for Payer: Multiplan Commercial $0.88
Service Code NDC 72516-031-01
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 $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.04
Rate for Payer: Multiplan Commercial $0.05
Service Code NDC 65862-064-01
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 57664-167-52
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 62584-267-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.27
Rate for Payer: Cash Price $0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.27
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.19
Rate for Payer: Multiplan Commercial $0.26
Service Code NDC 57237-102-01
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 62584-267-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.20
Rate for Payer: Aetna of CA Government/Medicare $0.20
Rate for Payer: Cash Price $0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.27
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.19
Rate for Payer: Multiplan Commercial $0.26
Service Code NDC 57237-102-01
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 62584-267-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.20
Rate for Payer: Aetna of CA Government/Medicare $0.20
Rate for Payer: Cash Price $0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.27
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.19
Rate for Payer: Multiplan Commercial $0.26
Service Code NDC 57664-167-52
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 52817-362-10
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 62332-114-31
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 62332-114-31
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 62584-267-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.27
Rate for Payer: Cash Price $0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.27
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.19
Rate for Payer: Multiplan Commercial $0.26
Service Code NDC 65862-064-01
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 52817-362-10
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 51079-255-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.09
Rate for Payer: Cash Price $0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.09
Rate for Payer: Health Smart Auto/Commercial $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.08
Service Code NDC 62584-265-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.08
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: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.08
Service Code NDC 57237-100-01
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 51079-255-20
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.07
Rate for Payer: Aetna of CA Government/Medicare $0.07
Rate for Payer: Cash Price $0.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.09
Rate for Payer: Health Smart Auto/Commercial $0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.08
Service Code NDC 62332-112-91
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 62332-112-31
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