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Service Code NDC 68094-001-62
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.25
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 $0.15
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 $0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.25
Service Code NDC 68094-001-59
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.26
Rate for Payer: Cash Price $0.15
Rate for Payer: Cigna of CA HMO/PPO $0.26
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.25
Service Code NDC 0054-0237-63
Hospital Charge Code 1715007
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.05
Rate for Payer: Cash Price $0.03
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.05
Service Code NDC 0054-0237-63
Hospital Charge Code 1715007
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: 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 Beech St/Commercial/PHCS $0.05
Service Code NDC 60687-760-40
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.25
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 $0.15
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 $0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.25
Service Code NDC 68094-001-62
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.26
Rate for Payer: Cash Price $0.15
Rate for Payer: Cigna of CA HMO/PPO $0.26
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.25
Service Code NDC 68094-001-59
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.25
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 $0.15
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 $0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.25
Service Code NDC 9999-9951-76
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.09
Rate for Payer: Cash Price $0.05
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.08
Service Code NDC 60687-760-40
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.26
Rate for Payer: Cash Price $0.15
Rate for Payer: Cigna of CA HMO/PPO $0.26
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.25
Service Code NDC 9999-9951-76
Hospital Charge Code 1734062
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.07
Rate for Payer: Aetna of CA Government/Medicare $0.07
Rate for Payer: Cash Price $0.05
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 Beech St/Commercial/PHCS $0.08
Service Code NDC 0054-0236-24
Hospital Charge Code 1731006
Hospital Revenue Code 259
Min. Negotiated Rate $0.85
Max. Negotiated Rate $1.23
Rate for Payer: Cash Price $0.69
Rate for Payer: Cigna of CA HMO/PPO $1.23
Rate for Payer: Health Smart Auto/Commercial $0.92
Rate for Payer: LLUH Dept of Risk Management WC $0.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS $1.16
Service Code NDC 0054-0236-24
Hospital Charge Code 1731006
Hospital Revenue Code 259
Min. Negotiated Rate $0.85
Max. Negotiated Rate $1.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.92
Rate for Payer: Aetna of CA Government/Medicare $0.92
Rate for Payer: Cash Price $0.69
Rate for Payer: Health Smart Auto/Commercial $0.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.92
Rate for Payer: LLUH Dept of Risk Management WC $0.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS $1.16
Service Code CPT J2272
Hospital Charge Code 1737083
Hospital Revenue Code 636
Min. Negotiated Rate $1.89
Max. Negotiated Rate $2.58
Rate for Payer: Cash Price $1.55
Rate for Payer: Health Smart Auto/Commercial $2.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $2.06
Rate for Payer: Aetna of CA Government/Medicare $2.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $2.06
Rate for Payer: LLUH Dept of Risk Management WC $1.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.58
Service Code CPT J2272
Hospital Charge Code 1737083
Hospital Revenue Code 636
Min. Negotiated Rate $1.89
Max. Negotiated Rate $2.75
Rate for Payer: Cash Price $1.55
Rate for Payer: Cigna of CA HMO/PPO $2.75
Rate for Payer: Health Smart Auto/Commercial $2.06
Rate for Payer: LLUH Dept of Risk Management WC $1.89
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.58
Service Code CPT J2270
Hospital Charge Code 1737083
Hospital Revenue Code 636
Min. Negotiated Rate $1.29
Max. Negotiated Rate $1.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $2.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.80
Rate for Payer: Aetna of CA Government/Medicare $1.80
Rate for Payer: Aetna of CA Government/Medicare $2.06
Rate for Payer: Aetna of CA Government/Medicare $1.40
Rate for Payer: Cash Price $1.05
Rate for Payer: Cash Price $1.35
Rate for Payer: Cash Price $1.55
Rate for Payer: Health Smart Auto/Commercial $2.06
Rate for Payer: Health Smart Auto/Commercial $1.40
Rate for Payer: Health Smart Auto/Commercial $1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $2.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.80
Rate for Payer: LLUH Dept of Risk Management WC $1.89
Rate for Payer: LLUH Dept of Risk Management WC $1.29
Rate for Payer: LLUH Dept of Risk Management WC $1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS $1.76
Service Code CPT J2270
Hospital Charge Code 1737083
Hospital Revenue Code 636
Min. Negotiated Rate $1.65
Max. Negotiated Rate $2.40
Rate for Payer: Cash Price $1.35
Rate for Payer: Cash Price $1.05
Rate for Payer: Cash Price $1.55
Rate for Payer: Cigna of CA HMO/PPO $2.40
Rate for Payer: Cigna of CA HMO/PPO $1.87
Rate for Payer: Cigna of CA HMO/PPO $2.75
Rate for Payer: Health Smart Auto/Commercial $1.80
Rate for Payer: Health Smart Auto/Commercial $1.40
Rate for Payer: Health Smart Auto/Commercial $2.06
Rate for Payer: LLUH Dept of Risk Management WC $1.65
Rate for Payer: LLUH Dept of Risk Management WC $1.89
Rate for Payer: LLUH Dept of Risk Management WC $1.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS $1.76
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.25
Service Code CPT J2270
Hospital Charge Code 1737083
Hospital Revenue Code 636
Min. Negotiated Rate $1.65
Max. Negotiated Rate $2.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.80
Rate for Payer: Aetna of CA Government/Medicare $1.80
Rate for Payer: Cash Price $1.35
Rate for Payer: Health Smart Auto/Commercial $1.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.80
Rate for Payer: LLUH Dept of Risk Management WC $1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.25
Service Code CPT J2270
Hospital Charge Code 1737083
Hospital Revenue Code 636
Min. Negotiated Rate $1.65
Max. Negotiated Rate $2.40
Rate for Payer: Cash Price $1.35
Rate for Payer: Cigna of CA HMO/PPO $2.40
Rate for Payer: Health Smart Auto/Commercial $1.80
Rate for Payer: LLUH Dept of Risk Management WC $1.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS $2.25
Service Code CPT J2270
Hospital Charge Code 1737072
Hospital Revenue Code 636
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.17
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 $0.10
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 $0.17
Service Code CPT J2270
Hospital Charge Code 1737072
Hospital Revenue Code 636
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.18
Rate for Payer: Cash Price $0.10
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.17
Service Code CPT J2270
Hospital Charge Code 1737072
Hospital Revenue Code 636
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.13
Rate for Payer: Aetna of CA Government/Medicare $0.13
Rate for Payer: Cash Price $0.09
Rate for Payer: Health Smart Auto/Commercial $0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.16
Service Code CPT J2270
Hospital Charge Code 1737072
Hospital Revenue Code 636
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.17
Rate for Payer: Cash Price $0.09
Rate for Payer: Cigna of CA HMO/PPO $0.17
Rate for Payer: Health Smart Auto/Commercial $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.16
Service Code CPT J2270
Hospital Charge Code 1737072
Hospital Revenue Code 636
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.13
Rate for Payer: Aetna of CA Government/Medicare $0.13
Rate for Payer: Cash Price $0.09
Rate for Payer: Health Smart Auto/Commercial $0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.16
Service Code CPT J2270
Hospital Charge Code 1737072
Hospital Revenue Code 636
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.17
Rate for Payer: Cash Price $0.09
Rate for Payer: Cigna of CA HMO/PPO $0.17
Rate for Payer: Health Smart Auto/Commercial $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.16
Service Code CPT J2270
Hospital Charge Code 1737072
Hospital Revenue Code 636
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.17
Rate for Payer: Cash Price $0.09
Rate for Payer: Cigna of CA HMO/PPO $0.17
Rate for Payer: Health Smart Auto/Commercial $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.16