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Service Code NDC 0904-5676-61
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.53
Max. Negotiated Rate $0.77
Rate for Payer: Cash Price $0.43
Rate for Payer: Cigna of CA HMO/PPO $0.77
Rate for Payer: Health Smart Auto/Commercial $0.58
Rate for Payer: LLUH Dept of Risk Management WC $0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.72
Service Code NDC 0904-5676-61
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.53
Max. Negotiated Rate $0.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.58
Rate for Payer: Aetna of CA Government/Medicare $0.58
Rate for Payer: Cash Price $0.43
Rate for Payer: Health Smart Auto/Commercial $0.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.58
Rate for Payer: LLUH Dept of Risk Management WC $0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.72
Service Code NDC 68084-044-11
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.56
Max. Negotiated Rate $0.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.61
Rate for Payer: Aetna of CA Government/Medicare $0.61
Rate for Payer: Cash Price $0.46
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: LLUH Dept of Risk Management WC $0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.77
Service Code NDC 43547-347-03
Hospital Charge Code 1713121
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 $0.11
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
Service Code NDC 50268-640-15
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.48
Rate for Payer: Aetna of CA Government/Medicare $0.48
Rate for Payer: Cash Price $0.36
Rate for Payer: Health Smart Auto/Commercial $0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.48
Rate for Payer: LLUH Dept of Risk Management WC $0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.60
Service Code NDC 50268-640-11
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.64
Rate for Payer: Cash Price $0.36
Rate for Payer: Cigna of CA HMO/PPO $0.64
Rate for Payer: Health Smart Auto/Commercial $0.48
Rate for Payer: LLUH Dept of Risk Management WC $0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.60
Service Code NDC 50268-640-15
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.64
Rate for Payer: Cash Price $0.36
Rate for Payer: Cigna of CA HMO/PPO $0.64
Rate for Payer: Health Smart Auto/Commercial $0.48
Rate for Payer: LLUH Dept of Risk Management WC $0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.60
Service Code NDC 68084-044-01
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.56
Max. Negotiated Rate $0.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.61
Rate for Payer: Aetna of CA Government/Medicare $0.61
Rate for Payer: Cash Price $0.46
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: LLUH Dept of Risk Management WC $0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.77
Service Code NDC 68084-044-01
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.56
Max. Negotiated Rate $0.82
Rate for Payer: Cash Price $0.46
Rate for Payer: Cigna of CA HMO/PPO $0.82
Rate for Payer: Health Smart Auto/Commercial $0.61
Rate for Payer: LLUH Dept of Risk Management WC $0.56
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.77
Service Code NDC 43547-347-03
Hospital Charge Code 1713121
Hospital Revenue Code 259
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
Service Code NDC 68382-097-06
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.11
Rate for Payer: Cash Price $0.06
Rate for Payer: Cigna of CA HMO/PPO $0.11
Rate for Payer: Health Smart Auto/Commercial $0.08
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.11
Service Code NDC 0378-7001-93
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.11
Rate for Payer: Cash Price $0.06
Rate for Payer: Cigna of CA HMO/PPO $0.11
Rate for Payer: Health Smart Auto/Commercial $0.08
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.11
Service Code NDC 0378-7001-93
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.08
Rate for Payer: Aetna of CA Government/Medicare $0.08
Rate for Payer: Cash Price $0.06
Rate for Payer: Health Smart Auto/Commercial $0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.08
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.11
Service Code NDC 0904-5677-61
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.23
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 $0.14
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 Beech St/Commercial/PHCS $0.23
Service Code NDC 68084-045-11
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.29
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 $0.18
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 Beech St/Commercial/PHCS $0.29
Service Code NDC 60505-0083-1
Hospital Charge Code 1711583
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 $0.08
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
Service Code NDC 60505-0083-1
Hospital Charge Code 1711583
Hospital Revenue Code 259
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
Service Code NDC 68382-098-06
Hospital Charge Code 1711583
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 $0.08
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
Service Code NDC 0904-5677-61
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.24
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.23
Service Code NDC 68084-045-01
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.29
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 $0.18
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 Beech St/Commercial/PHCS $0.29
Service Code NDC 68382-098-06
Hospital Charge Code 1711583
Hospital Revenue Code 259
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
Service Code NDC 68084-045-11
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.31
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.29
Service Code NDC 68084-045-01
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.31
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.29
Service Code NDC 50268-642-11
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.30
Max. Negotiated Rate $0.44
Rate for Payer: Cash Price $0.25
Rate for Payer: Cigna of CA HMO/PPO $0.44
Rate for Payer: Health Smart Auto/Commercial $0.33
Rate for Payer: LLUH Dept of Risk Management WC $0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.41
Service Code NDC 68084-046-11
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.63
Max. Negotiated Rate $0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.68
Rate for Payer: Aetna of CA Government/Medicare $0.68
Rate for Payer: Cash Price $0.51
Rate for Payer: Health Smart Auto/Commercial $0.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.68
Rate for Payer: LLUH Dept of Risk Management WC $0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.86