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All Charges

Charge Type Setting Price  
Service Code NDC 60687-230-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.36
Max. Negotiated Rate $0.53
Rate for Payer: Cash Price $0.37
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
Service Code NDC 68462-128-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.15
Rate for Payer: Cash Price $0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.15
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 68001-242-00
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 68462-128-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.11
Rate for Payer: Aetna of CA Government/Medicare $0.11
Rate for Payer: Cash Price $0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.15
Rate for Payer: Health Smart Auto/Commercial $0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.10
Rate for Payer: Multiplan Commercial $0.14
Service Code NDC 68001-242-00
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 9994-0803-61
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 9994-0803-61
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