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Service Code NDC 64380-712-06
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.20
Max. Negotiated Rate $0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.22
Rate for Payer: Aetna of CA Government/Medicare $0.22
Rate for Payer: Cash Price $0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.29
Rate for Payer: Health Smart Auto/Commercial $0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.22
Rate for Payer: LLUH Dept of Risk Management WC $0.20
Rate for Payer: Multiplan Commercial $0.27
Service Code NDC 68084-214-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.31
Max. Negotiated Rate $0.45
Rate for Payer: Cash Price $0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.45
Rate for Payer: Health Smart Auto/Commercial $0.34
Rate for Payer: LLUH Dept of Risk Management WC $0.31
Rate for Payer: Multiplan Commercial $0.42
Service Code NDC 64380-712-06
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.20
Max. Negotiated Rate $0.29
Rate for Payer: Cash Price $0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.29
Rate for Payer: Health Smart Auto/Commercial $0.22
Rate for Payer: LLUH Dept of Risk Management WC $0.20
Rate for Payer: Multiplan Commercial $0.27
Service Code NDC 68084-214-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.31
Max. Negotiated Rate $0.45
Rate for Payer: Cash Price $0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.45
Rate for Payer: Health Smart Auto/Commercial $0.34
Rate for Payer: LLUH Dept of Risk Management WC $0.31
Rate for Payer: Multiplan Commercial $0.42
Service Code NDC 0904-7153-61
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.32
Max. Negotiated Rate $0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.35
Rate for Payer: Aetna of CA Government/Medicare $0.35
Rate for Payer: Cash Price $0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.47
Rate for Payer: Health Smart Auto/Commercial $0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.35
Rate for Payer: LLUH Dept of Risk Management WC $0.32
Rate for Payer: Multiplan Commercial $0.44
Service Code NDC 0904-7153-61
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.32
Max. Negotiated Rate $0.47
Rate for Payer: Cash Price $0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.47
Rate for Payer: Health Smart Auto/Commercial $0.35
Rate for Payer: LLUH Dept of Risk Management WC $0.32
Rate for Payer: Multiplan Commercial $0.44
Service Code NDC 68382-247-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.14
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 $0.14
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 $0.13
Service Code NDC 42806-714-01
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 69452-143-20
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.20
Max. Negotiated Rate $0.29
Rate for Payer: Cash Price $0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.29
Rate for Payer: Health Smart Auto/Commercial $0.22
Rate for Payer: LLUH Dept of Risk Management WC $0.20
Rate for Payer: Multiplan Commercial $0.27
Service Code NDC 68084-214-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.31
Max. Negotiated Rate $0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.34
Rate for Payer: Aetna of CA Government/Medicare $0.34
Rate for Payer: Cash Price $0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.45
Rate for Payer: Health Smart Auto/Commercial $0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.34
Rate for Payer: LLUH Dept of Risk Management WC $0.31
Rate for Payer: Multiplan Commercial $0.42
Service Code NDC 51224-001-50
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.31
Rate for Payer: Cash Price $0.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.31
Rate for Payer: Health Smart Auto/Commercial $0.23
Rate for Payer: LLUH Dept of Risk Management WC $0.21
Rate for Payer: Multiplan Commercial $0.29
Service Code NDC 51224-001-50
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.23
Rate for Payer: Aetna of CA Government/Medicare $0.23
Rate for Payer: Cash Price $0.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.31
Rate for Payer: Health Smart Auto/Commercial $0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.23
Rate for Payer: LLUH Dept of Risk Management WC $0.21
Rate for Payer: Multiplan Commercial $0.29
Service Code NDC 67405-830-05
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 67405-830-05
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 0536-1351-42
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.04
Rate for Payer: Cash Price $0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.04
Rate for Payer: Health Smart Auto/Commercial $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.04
Service Code NDC 0536-1351-42
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.03
Rate for Payer: Aetna of CA Government/Medicare $0.03
Rate for Payer: Cash Price $0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.04
Rate for Payer: Health Smart Auto/Commercial $0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.04
Service Code NDC 45802-308-96
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 $0.17
Rate for Payer: Aetna of CA Government/Medicare $0.17
Rate for Payer: Cash Price $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.22
Rate for Payer: Health Smart Auto/Commercial $0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.21
Service Code NDC 45802-308-96
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.22
Rate for Payer: Cash Price $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.22
Rate for Payer: Health Smart Auto/Commercial $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.21
Service Code NDC 24470-911-08
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.60
Max. Negotiated Rate $0.87
Rate for Payer: Cash Price $0.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.87
Rate for Payer: Health Smart Auto/Commercial $0.65
Rate for Payer: LLUH Dept of Risk Management WC $0.60
Rate for Payer: Multiplan Commercial $0.82
Service Code NDC 24470-911-08
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.60
Max. Negotiated Rate $0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.65
Rate for Payer: Aetna of CA Government/Medicare $0.65
Rate for Payer: Cash Price $0.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.87
Rate for Payer: Health Smart Auto/Commercial $0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.65
Rate for Payer: LLUH Dept of Risk Management WC $0.60
Rate for Payer: Multiplan Commercial $0.82
Service Code NDC 45802-280-01
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 45802-280-01
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 45802-216-96
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 $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.21
Service Code NDC 0536-1055-56
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 45802-216-96
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 $0.17
Rate for Payer: Aetna of CA Government/Medicare $0.17
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 $0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.21