Price Transparency

Know your out-of-pocket cost for care.

search
Charge Type Setting Price  
Service Code HCPCS J0572
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $1.47
Max. Negotiated Rate $2.14
Rate for Payer: Cash Price $1.47
Rate for Payer: Cash Price $1.87
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $2.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $2.71
Rate for Payer: Health Smart Auto/Commercial $2.03
Rate for Payer: Health Smart Auto/Commercial $1.60
Rate for Payer: LLUH Dept of Risk Management WC $1.47
Rate for Payer: LLUH Dept of Risk Management WC $1.86
Rate for Payer: Multiplan Commercial $2.54
Rate for Payer: Multiplan Commercial $2.00
Service Code HCPCS J0572
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $1.67
Max. Negotiated Rate $2.43
Rate for Payer: Cash Price $1.67
Rate for Payer: Cash Price $0.61
Rate for Payer: Cash Price $0.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $2.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.89
Rate for Payer: Health Smart Auto/Commercial $0.67
Rate for Payer: Health Smart Auto/Commercial $0.80
Rate for Payer: Health Smart Auto/Commercial $1.82
Rate for Payer: LLUH Dept of Risk Management WC $1.67
Rate for Payer: LLUH Dept of Risk Management WC $0.61
Rate for Payer: LLUH Dept of Risk Management WC $0.73
Rate for Payer: Multiplan Commercial $0.83
Rate for Payer: Multiplan Commercial $1.00
Rate for Payer: Multiplan Commercial $2.28
Service Code HCPCS J0572
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $1.67
Max. Negotiated Rate $2.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.80
Rate for Payer: Aetna of CA Government/Medicare $0.67
Rate for Payer: Aetna of CA Government/Medicare $1.82
Rate for Payer: Aetna of CA Government/Medicare $0.80
Rate for Payer: Cash Price $0.61
Rate for Payer: Cash Price $1.67
Rate for Payer: Cash Price $0.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $2.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.89
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.06
Rate for Payer: Health Smart Auto/Commercial $0.67
Rate for Payer: Health Smart Auto/Commercial $0.80
Rate for Payer: Health Smart Auto/Commercial $1.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.82
Rate for Payer: LLUH Dept of Risk Management WC $0.73
Rate for Payer: LLUH Dept of Risk Management WC $0.61
Rate for Payer: LLUH Dept of Risk Management WC $1.67
Rate for Payer: Multiplan Commercial $0.83
Rate for Payer: Multiplan Commercial $1.00
Rate for Payer: Multiplan Commercial $2.28
Service Code NDC 42858-750-40
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $35.44
Max. Negotiated Rate $51.54
Rate for Payer: Cash Price $35.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $51.54
Rate for Payer: Health Smart Auto/Commercial $38.66
Rate for Payer: LLUH Dept of Risk Management WC $35.44
Rate for Payer: Multiplan Commercial $48.32
Service Code NDC 42858-750-40
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $35.44
Max. Negotiated Rate $51.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $38.66
Rate for Payer: Aetna of CA Government/Medicare $38.66
Rate for Payer: Cash Price $35.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $51.54
Rate for Payer: Health Smart Auto/Commercial $38.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $38.66
Rate for Payer: LLUH Dept of Risk Management WC $35.44
Rate for Payer: Multiplan Commercial $48.32
Service Code HCPCS J0574
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $2.63
Max. Negotiated Rate $3.82
Rate for Payer: Cash Price $2.63
Rate for Payer: Cash Price $2.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $3.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $3.82
Rate for Payer: Health Smart Auto/Commercial $2.87
Rate for Payer: Health Smart Auto/Commercial $2.45
Rate for Payer: LLUH Dept of Risk Management WC $2.24
Rate for Payer: LLUH Dept of Risk Management WC $2.63
Rate for Payer: Multiplan Commercial $3.06
Rate for Payer: Multiplan Commercial $3.58
Service Code HCPCS J0574
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $2.24
Max. Negotiated Rate $3.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $2.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $2.87
Rate for Payer: Aetna of CA Government/Medicare $2.87
Rate for Payer: Aetna of CA Government/Medicare $2.45
Rate for Payer: Cash Price $2.63
Rate for Payer: Cash Price $2.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $3.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $3.82
Rate for Payer: Health Smart Auto/Commercial $2.45
Rate for Payer: Health Smart Auto/Commercial $2.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $2.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $2.87
Rate for Payer: LLUH Dept of Risk Management WC $2.24
Rate for Payer: LLUH Dept of Risk Management WC $2.63
Rate for Payer: Multiplan Commercial $3.58
Rate for Payer: Multiplan Commercial $3.06
Service Code HCPCS J0592
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $8.99
Max. Negotiated Rate $13.07
Rate for Payer: Cash Price $8.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $13.07
Rate for Payer: Health Smart Auto/Commercial $9.80
Rate for Payer: LLUH Dept of Risk Management WC $8.99
Rate for Payer: Multiplan Commercial $12.26
Service Code HCPCS J0592
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $8.99
Max. Negotiated Rate $13.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $9.80
Rate for Payer: Aetna of CA Government/Medicare $9.80
Rate for Payer: Cash Price $8.99
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $13.07
Rate for Payer: Health Smart Auto/Commercial $9.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $9.80
Rate for Payer: LLUH Dept of Risk Management WC $8.99
Rate for Payer: Multiplan Commercial $12.26
Service Code HCPCS J0571
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.38
Rate for Payer: Aetna of CA Government/Medicare $0.38
Rate for Payer: Cash Price $0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.51
Rate for Payer: Health Smart Auto/Commercial $0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.38
Rate for Payer: LLUH Dept of Risk Management WC $0.35
Rate for Payer: Multiplan Commercial $0.48
Service Code HCPCS J0571
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.51
Rate for Payer: Cash Price $0.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.51
Rate for Payer: Health Smart Auto/Commercial $0.38
Rate for Payer: LLUH Dept of Risk Management WC $0.35
Rate for Payer: Multiplan Commercial $0.48
Service Code HCPCS J0571
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $2.31
Max. Negotiated Rate $3.36
Rate for Payer: Cash Price $2.31
Rate for Payer: Cash Price $0.53
Rate for Payer: Cash Price $1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $3.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.77
Rate for Payer: Health Smart Auto/Commercial $0.58
Rate for Payer: Health Smart Auto/Commercial $1.20
Rate for Payer: Health Smart Auto/Commercial $2.52
Rate for Payer: LLUH Dept of Risk Management WC $2.31
Rate for Payer: LLUH Dept of Risk Management WC $0.53
Rate for Payer: LLUH Dept of Risk Management WC $1.10
Rate for Payer: Multiplan Commercial $0.72
Rate for Payer: Multiplan Commercial $1.50
Rate for Payer: Multiplan Commercial $3.15
Service Code HCPCS J0571
Hospital Charge Code 901700054
Hospital Revenue Code 636
Min. Negotiated Rate $2.31
Max. Negotiated Rate $3.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $2.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.20
Rate for Payer: Aetna of CA Government/Medicare $0.58
Rate for Payer: Aetna of CA Government/Medicare $2.52
Rate for Payer: Aetna of CA Government/Medicare $1.20
Rate for Payer: Cash Price $0.53
Rate for Payer: Cash Price $2.31
Rate for Payer: Cash Price $1.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $3.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.60
Rate for Payer: Health Smart Auto/Commercial $0.58
Rate for Payer: Health Smart Auto/Commercial $1.20
Rate for Payer: Health Smart Auto/Commercial $2.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $2.52
Rate for Payer: LLUH Dept of Risk Management WC $1.10
Rate for Payer: LLUH Dept of Risk Management WC $0.53
Rate for Payer: LLUH Dept of Risk Management WC $2.31
Rate for Payer: Multiplan Commercial $0.72
Rate for Payer: Multiplan Commercial $1.50
Rate for Payer: Multiplan Commercial $3.15
Service Code NDC 68001-309-00
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.64
Rate for Payer: Cash Price $0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial $0.60
Service Code NDC 50268-143-15
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.17
Max. Negotiated Rate $1.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.27
Rate for Payer: Aetna of CA Government/Medicare $1.27
Rate for Payer: Cash Price $1.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.70
Rate for Payer: Health Smart Auto/Commercial $1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.27
Rate for Payer: LLUH Dept of Risk Management WC $1.17
Rate for Payer: Multiplan Commercial $1.59
Service Code NDC 68001-309-00
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.64
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 $0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.64
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 Commercial $0.60
Service Code NDC 50268-143-15
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.17
Max. Negotiated Rate $1.70
Rate for Payer: Cash Price $1.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.70
Rate for Payer: Health Smart Auto/Commercial $1.27
Rate for Payer: LLUH Dept of Risk Management WC $1.17
Rate for Payer: Multiplan Commercial $1.59
Service Code NDC 60505-0157-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.47
Max. Negotiated Rate $0.69
Rate for Payer: Cash Price $0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.69
Rate for Payer: Health Smart Auto/Commercial $0.52
Rate for Payer: LLUH Dept of Risk Management WC $0.47
Rate for Payer: Multiplan Commercial $0.65
Service Code NDC 23155-192-01
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 23155-192-01
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 50268-143-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.17
Max. Negotiated Rate $1.70
Rate for Payer: Cash Price $1.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.70
Rate for Payer: Health Smart Auto/Commercial $1.27
Rate for Payer: LLUH Dept of Risk Management WC $1.17
Rate for Payer: Multiplan Commercial $1.59
Service Code NDC 0904-7530-60
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.03
Rate for Payer: Aetna of CA Government/Medicare $0.03
Rate for Payer: Cash Price $0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.04
Rate for Payer: Health Smart Auto/Commercial $0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.04
Service Code NDC 60505-0157-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.47
Max. Negotiated Rate $0.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.52
Rate for Payer: Aetna of CA Government/Medicare $0.52
Rate for Payer: Cash Price $0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.69
Rate for Payer: Health Smart Auto/Commercial $0.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.52
Rate for Payer: LLUH Dept of Risk Management WC $0.47
Rate for Payer: Multiplan Commercial $0.65
Service Code NDC 50268-143-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.17
Max. Negotiated Rate $1.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $1.27
Rate for Payer: Aetna of CA Government/Medicare $1.27
Rate for Payer: Cash Price $1.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $1.70
Rate for Payer: Health Smart Auto/Commercial $1.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $1.27
Rate for Payer: LLUH Dept of Risk Management WC $1.17
Rate for Payer: Multiplan Commercial $1.59
Service Code NDC 0904-7530-60
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.04
Rate for Payer: Cash Price $0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.04
Rate for Payer: Health Smart Auto/Commercial $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.04