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Service Code NDC 0832-1217-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.37
Max. Negotiated Rate $0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.40
Rate for Payer: Aetna of CA Government/Medicare $0.40
Rate for Payer: Cash Price $0.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.54
Rate for Payer: Health Smart Auto/Commercial $0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.40
Rate for Payer: LLUH Dept of Risk Management WC $0.37
Rate for Payer: Multiplan Commercial $0.50
Service Code NDC 0832-1217-89
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.37
Max. Negotiated Rate $0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.40
Rate for Payer: Aetna of CA Government/Medicare $0.40
Rate for Payer: Cash Price $0.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.54
Rate for Payer: Health Smart Auto/Commercial $0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.40
Rate for Payer: LLUH Dept of Risk Management WC $0.37
Rate for Payer: Multiplan Commercial $0.50
Service Code NDC 65162-767-10
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.16
Max. Negotiated Rate $0.23
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 $0.23
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 $0.16
Rate for Payer: Multiplan Commercial $0.22
Service Code NDC 0832-1217-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.37
Max. Negotiated Rate $0.54
Rate for Payer: Cash Price $0.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.54
Rate for Payer: Health Smart Auto/Commercial $0.40
Rate for Payer: LLUH Dept of Risk Management WC $0.37
Rate for Payer: Multiplan Commercial $0.50
Service Code NDC 0832-1218-89
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.39
Max. Negotiated Rate $0.56
Rate for Payer: Cash Price $0.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.56
Rate for Payer: Health Smart Auto/Commercial $0.42
Rate for Payer: LLUH Dept of Risk Management WC $0.39
Rate for Payer: Multiplan Commercial $0.53
Service Code NDC 0832-1218-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.39
Max. Negotiated Rate $0.56
Rate for Payer: Cash Price $0.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.56
Rate for Payer: Health Smart Auto/Commercial $0.42
Rate for Payer: LLUH Dept of Risk Management WC $0.39
Rate for Payer: Multiplan Commercial $0.53
Service Code NDC 0832-1218-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.39
Max. Negotiated Rate $0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.42
Rate for Payer: Aetna of CA Government/Medicare $0.42
Rate for Payer: Cash Price $0.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.56
Rate for Payer: Health Smart Auto/Commercial $0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.42
Rate for Payer: LLUH Dept of Risk Management WC $0.39
Rate for Payer: Multiplan Commercial $0.53
Service Code NDC 0832-1218-89
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.39
Max. Negotiated Rate $0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.42
Rate for Payer: Aetna of CA Government/Medicare $0.42
Rate for Payer: Cash Price $0.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.56
Rate for Payer: Health Smart Auto/Commercial $0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.42
Rate for Payer: LLUH Dept of Risk Management WC $0.39
Rate for Payer: Multiplan Commercial $0.53
Service Code NDC 0832-1211-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.24
Max. Negotiated Rate $0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.26
Rate for Payer: Aetna of CA Government/Medicare $0.26
Rate for Payer: Cash Price $0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.35
Rate for Payer: Health Smart Auto/Commercial $0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.33
Service Code NDC 0832-1211-89
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.24
Max. Negotiated Rate $0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.26
Rate for Payer: Aetna of CA Government/Medicare $0.26
Rate for Payer: Cash Price $0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.35
Rate for Payer: Health Smart Auto/Commercial $0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.33
Service Code NDC 0832-1211-89
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.24
Max. Negotiated Rate $0.35
Rate for Payer: Cash Price $0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.35
Rate for Payer: Health Smart Auto/Commercial $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.33
Service Code NDC 0832-1211-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.24
Max. Negotiated Rate $0.35
Rate for Payer: Cash Price $0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.35
Rate for Payer: Health Smart Auto/Commercial $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.33
Service Code NDC 0409-3977-03
Hospital Charge Code 901700004
Hospital Revenue Code 250
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 0409-3977-03
Hospital Charge Code 901700004
Hospital Revenue Code 250
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 HCPCS A4216
Hospital Charge Code 901700017
Hospital Revenue Code 272
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 EPO/HMO/POS/PPO $0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.36
Rate for Payer: Aetna of CA Government/Medicare $0.36
Rate for Payer: Aetna of CA Government/Medicare $0.23
Rate for Payer: Aetna of CA Government/Medicare $0.12
Rate for Payer: Aetna of CA Government/Medicare $0.17
Rate for Payer: Aetna of CA Government/Medicare $0.22
Rate for Payer: Aetna of CA Government/Medicare $0.10
Rate for Payer: Aetna of CA Government/Medicare $0.25
Rate for Payer: Cash Price $0.22
Rate for Payer: Cash Price $0.33
Rate for Payer: Cash Price $0.21
Rate for Payer: Cash Price $0.11
Rate for Payer: Cash Price $0.09
Rate for Payer: Cash Price $0.23
Rate for Payer: Cash Price $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.31
Rate for Payer: Health Smart Auto/Commercial $0.22
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: Health Smart Auto/Commercial $0.12
Rate for Payer: Health Smart Auto/Commercial $0.17
Rate for Payer: Health Smart Auto/Commercial $0.23
Rate for Payer: Health Smart Auto/Commercial $0.25
Rate for Payer: Health Smart Auto/Commercial $0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.23
Rate for Payer: LLUH Dept of Risk Management WC $0.21
Rate for Payer: LLUH Dept of Risk Management WC $0.33
Rate for Payer: LLUH Dept of Risk Management WC $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.20
Rate for Payer: Multiplan Commercial $0.45
Rate for Payer: Multiplan Commercial $0.28
Rate for Payer: Multiplan Commercial $0.31
Rate for Payer: Multiplan Commercial $0.13
Rate for Payer: Multiplan Commercial $0.22
Rate for Payer: Multiplan Commercial $0.29
Rate for Payer: Multiplan Commercial $0.15
Service Code HCPCS A4216
Hospital Charge Code 901700017
Hospital Revenue Code 272
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.14
Rate for Payer: Cash Price $0.09
Rate for Payer: Cash Price $0.33
Rate for Payer: Cash Price $0.23
Rate for Payer: Cash Price $0.16
Rate for Payer: Cash Price $0.11
Rate for Payer: Cash Price $0.21
Rate for Payer: Cash Price $0.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.48
Rate for Payer: Health Smart Auto/Commercial $0.22
Rate for Payer: Health Smart Auto/Commercial $0.10
Rate for Payer: Health Smart Auto/Commercial $0.12
Rate for Payer: Health Smart Auto/Commercial $0.17
Rate for Payer: Health Smart Auto/Commercial $0.23
Rate for Payer: Health Smart Auto/Commercial $0.25
Rate for Payer: Health Smart Auto/Commercial $0.36
Rate for Payer: LLUH Dept of Risk Management WC $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.21
Rate for Payer: LLUH Dept of Risk Management WC $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.33
Rate for Payer: LLUH Dept of Risk Management WC $0.23
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.20
Rate for Payer: Multiplan Commercial $0.22
Rate for Payer: Multiplan Commercial $0.45
Rate for Payer: Multiplan Commercial $0.31
Rate for Payer: Multiplan Commercial $0.29
Rate for Payer: Multiplan Commercial $0.15
Rate for Payer: Multiplan Commercial $0.13
Rate for Payer: Multiplan Commercial $0.28
Service Code NDC 0264-7850-00
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.01
Rate for Payer: Aetna of CA Government/Medicare $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.01
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.01
Service Code NDC 0264-7850-20
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.02
Rate for Payer: Cash Price $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 0264-7850-00
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.01
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.01
Service Code NDC 0264-7850-10
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Cash Price $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.01
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.01
Service Code NDC 0264-7850-20
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.01
Rate for Payer: Aetna of CA Government/Medicare $0.01
Rate for Payer: Cash Price $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.02
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 0264-7850-10
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.01
Rate for Payer: Aetna of CA Government/Medicare $0.01
Rate for Payer: Cash Price $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.01
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.01
Service Code NDC 0264-2101-10
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.01
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.01
Service Code NDC 0264-2101-10
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.01
Rate for Payer: Aetna of CA Government/Medicare $0.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.01
Rate for Payer: Health Smart Auto/Commercial $0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.01
Service Code NDC 7214045231
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 $0.06
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