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Service Code NDC 43598-863-60
Hospital Charge Code 901700030
Hospital Revenue Code 259
Min. Negotiated Rate $0.24
Max. Negotiated Rate $0.34
Rate for Payer: Cash Price $0.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.34
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 $0.32
Service Code NDC 43598-863-60
Hospital Charge Code 901700030
Hospital Revenue Code 259
Min. Negotiated Rate $0.24
Max. Negotiated Rate $0.34
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 $0.34
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 $0.32
Service Code NDC 60505-0158-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
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 NDC 23155-191-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.27
Rate for Payer: Cash Price $0.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.27
Rate for Payer: Health Smart Auto/Commercial $0.20
Rate for Payer: LLUH Dept of Risk Management WC $0.19
Rate for Payer: Multiplan Commercial $0.26
Service Code NDC 0904-7529-60
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.02
Rate for Payer: Aetna of CA Government/Medicare $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.03
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.03
Service Code NDC 68001-308-00
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.33
Max. Negotiated Rate $0.48
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: Cash Price $0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.48
Rate for Payer: Health Smart Auto/Commercial $0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.36
Rate for Payer: LLUH Dept of Risk Management WC $0.33
Rate for Payer: Multiplan Commercial $0.45
Service Code NDC 0904-7529-60
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.03
Rate for Payer: Cash Price $0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.03
Rate for Payer: Health Smart Auto/Commercial $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.03
Service Code NDC 23155-191-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.27
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 $0.27
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 $0.19
Rate for Payer: Multiplan Commercial $0.26
Service Code NDC 68001-308-00
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.33
Max. Negotiated Rate $0.48
Rate for Payer: Cash Price $0.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.48
Rate for Payer: Health Smart Auto/Commercial $0.36
Rate for Payer: LLUH Dept of Risk Management WC $0.33
Rate for Payer: Multiplan Commercial $0.45
Service Code NDC 60505-0158-1
Hospital Charge Code 901700029
Hospital Revenue Code 259
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 NDC 42806-410-60
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 68084-697-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.53
Max. Negotiated Rate $0.77
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 $0.53
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: 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 Commercial $0.72
Service Code NDC 68084-697-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.53
Max. Negotiated Rate $0.77
Rate for Payer: Cash Price $0.53
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: LLUH Dept of Risk Management WC $0.53
Rate for Payer: Multiplan Commercial $0.72
Service Code NDC 68084-697-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.53
Max. Negotiated Rate $0.77
Rate for Payer: Cash Price $0.53
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: LLUH Dept of Risk Management WC $0.53
Rate for Payer: Multiplan Commercial $0.72
Service Code NDC 0591-3540-60
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.24
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 $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.24
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 Commercial $0.23
Service Code NDC 68084-697-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.53
Max. Negotiated Rate $0.77
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 $0.53
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: 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 Commercial $0.72
Service Code NDC 0591-3540-60
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.24
Rate for Payer: Cash Price $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial $0.23
Service Code NDC 42806-410-60
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 68084-708-25
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.40
Max. Negotiated Rate $0.58
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 $0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.58
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 $0.40
Rate for Payer: Multiplan Commercial $0.55
Service Code NDC 68084-708-95
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.40
Max. Negotiated Rate $0.58
Rate for Payer: Cash Price $0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.58
Rate for Payer: Health Smart Auto/Commercial $0.44
Rate for Payer: LLUH Dept of Risk Management WC $0.40
Rate for Payer: Multiplan Commercial $0.55
Service Code NDC 68084-708-95
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.40
Max. Negotiated Rate $0.58
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 $0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.58
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 $0.40
Rate for Payer: Multiplan Commercial $0.55
Service Code NDC 43547-289-10
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.24
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 $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.24
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 Commercial $0.23
Service Code NDC 43547-289-10
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.24
Rate for Payer: Cash Price $0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial $0.23
Service Code NDC 43547-289-50
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 $0.19
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Commercial $0.24
Service Code NDC 68084-708-25
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.40
Max. Negotiated Rate $0.58
Rate for Payer: Cash Price $0.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO $0.58
Rate for Payer: Health Smart Auto/Commercial $0.44
Rate for Payer: LLUH Dept of Risk Management WC $0.40
Rate for Payer: Multiplan Commercial $0.55