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All Charges

Charge Type Setting Price  
Service Code NDC 51672-1282-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.26
Rate for Payer: Cash Price $0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial $0.25
Service Code NDC 45802-064-36
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 $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Multiplan Commercial $0.09
Service Code NDC 51672-1282-2
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.20
Rate for Payer: Cash Price $0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.20
Rate for Payer: Health Smart Auto/Commercial $0.15
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.19
Service Code NDC 45802-064-35
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.21
Rate for Payer: Cash Price $0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.21
Rate for Payer: Health Smart Auto/Commercial $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.20
Service Code NDC 45802-064-35
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.16
Rate for Payer: Aetna of CA Government/Medicare $0.16
Rate for Payer: Cash Price $0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.21
Rate for Payer: Health Smart Auto/Commercial $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.20
Service Code NDC 51672-1282-2
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.15
Rate for Payer: Aetna of CA Government/Medicare $0.15
Rate for Payer: Cash Price $0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.20
Rate for Payer: Health Smart Auto/Commercial $0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.15
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.19
Service Code NDC 51672-1282-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.26
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 $0.26
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 Commercial $0.25
Service Code NDC 45802-064-36
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.10
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 $0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.10
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 $0.07
Rate for Payer: Multiplan Commercial $0.09
Service Code NDC 21922-063-15
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.11
Rate for Payer: Cash Price $0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial $0.11
Service Code NDC 45802-055-36
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.12
Rate for Payer: Cash Price $0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.12
Rate for Payer: Health Smart Auto/Commercial $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.11
Service Code NDC 0713-0228-80
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.11
Rate for Payer: Cash Price $0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial $0.11
Service Code NDC 0168-0006-80
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 $0.10
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 45802-055-35
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 51672-1284-8
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.12
Rate for Payer: Cash Price $0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.12
Rate for Payer: Health Smart Auto/Commercial $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.11
Service Code NDC 0168-0006-80
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
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 $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.13
Service Code NDC 51672-1284-8
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.09
Rate for Payer: Aetna of CA Government/Medicare $0.09
Rate for Payer: Cash Price $0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.12
Rate for Payer: Health Smart Auto/Commercial $0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.11
Service Code NDC 45802-055-35
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 21922-063-15
Hospital Charge Code 901700029
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 $0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.11
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 Commercial $0.11
Service Code NDC 45802-055-05
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.05
Rate for Payer: Aetna of CA Government/Medicare $0.05
Rate for Payer: Cash Price $0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.07
Rate for Payer: Health Smart Auto/Commercial $0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Multiplan Commercial $0.07
Service Code NDC 45802-055-05
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.07
Rate for Payer: Cash Price $0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.07
Rate for Payer: Health Smart Auto/Commercial $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Multiplan Commercial $0.07
Service Code NDC 45802-055-36
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.09
Rate for Payer: Aetna of CA Government/Medicare $0.09
Rate for Payer: Cash Price $0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.12
Rate for Payer: Health Smart Auto/Commercial $0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.11
Service Code NDC 0713-0228-80
Hospital Charge Code 901700029
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 $0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.11
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 Commercial $0.11
Service Code NDC 0168-0002-15
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.41
Max. Negotiated Rate $0.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.44
Rate for Payer: Aetna of CA Government/Medicare $0.44
Rate for Payer: Cash Price $0.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.59
Rate for Payer: Health Smart Auto/Commercial $0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.44
Rate for Payer: LLUH Dept of Risk Management WC $0.41
Rate for Payer: Multiplan Commercial $0.56
Service Code NDC 0168-0002-15
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.41
Max. Negotiated Rate $0.59
Rate for Payer: Cash Price $0.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.59
Rate for Payer: Health Smart Auto/Commercial $0.44
Rate for Payer: LLUH Dept of Risk Management WC $0.41
Rate for Payer: Multiplan Commercial $0.56
Service Code NDC 45802-065-35
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.36
Max. Negotiated Rate $0.53
Rate for Payer: Cash Price $0.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.53
Rate for Payer: Health Smart Auto/Commercial $0.40
Rate for Payer: LLUH Dept of Risk Management WC $0.36
Rate for Payer: Multiplan Commercial $0.50