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Charge Type Setting Price  
Service Code NDC 33342-327-80
Hospital Charge Code 1743435
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.07
Rate for Payer: Cash Price $0.04
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.07
Service Code NDC 0713-0229-80
Hospital Charge Code 1743370
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.09
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 $0.05
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 Beech St/Commercial/PHCS $0.09
Service Code NDC 0713-0229-15
Hospital Charge Code 1743372
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.19
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 $0.11
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 Beech St/Commercial/PHCS $0.19
Service Code NDC 0713-0229-80
Hospital Charge Code 1743370
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.10
Rate for Payer: Cash Price $0.05
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.09
Service Code NDC 0713-0229-15
Hospital Charge Code 1743372
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.20
Rate for Payer: Cash Price $0.11
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.19
Service Code NDC 45802-054-35
Hospital Charge Code 1743372
Hospital Revenue Code 259
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.24
Rate for Payer: Aetna of CA Government/Medicare $0.24
Rate for Payer: Cash Price $0.18
Rate for Payer: Health Smart Auto/Commercial $0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.24
Rate for Payer: LLUH Dept of Risk Management WC $0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.30
Service Code NDC 45802-054-35
Hospital Charge Code 1743372
Hospital Revenue Code 259
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.32
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA HMO/PPO $0.32
Rate for Payer: Health Smart Auto/Commercial $0.24
Rate for Payer: LLUH Dept of Risk Management WC $0.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.30
Service Code NDC 64980-320-05
Hospital Charge Code 1743376
Hospital Revenue Code 259
Min. Negotiated Rate $8.51
Max. Negotiated Rate $12.38
Rate for Payer: Cash Price $6.96
Rate for Payer: Cigna of CA HMO/PPO $12.38
Rate for Payer: Health Smart Auto/Commercial $9.28
Rate for Payer: LLUH Dept of Risk Management WC $8.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS $11.60
Service Code NDC 0713-0655-40
Hospital Charge Code 1743376
Hospital Revenue Code 259
Min. Negotiated Rate $8.51
Max. Negotiated Rate $11.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $9.28
Rate for Payer: Aetna of CA Government/Medicare $9.28
Rate for Payer: Cash Price $6.96
Rate for Payer: Health Smart Auto/Commercial $9.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $9.28
Rate for Payer: LLUH Dept of Risk Management WC $8.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS $11.60
Service Code NDC 51672-1267-5
Hospital Charge Code 1743376
Hospital Revenue Code 259
Min. Negotiated Rate $8.51
Max. Negotiated Rate $11.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $9.28
Rate for Payer: Aetna of CA Government/Medicare $9.28
Rate for Payer: Cash Price $6.96
Rate for Payer: Health Smart Auto/Commercial $9.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $9.28
Rate for Payer: LLUH Dept of Risk Management WC $8.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS $11.60
Service Code NDC 51672-1267-5
Hospital Charge Code 1743376
Hospital Revenue Code 259
Min. Negotiated Rate $8.51
Max. Negotiated Rate $12.38
Rate for Payer: Health Smart Auto/Commercial $9.28
Rate for Payer: Cash Price $6.96
Rate for Payer: Cigna of CA HMO/PPO $12.38
Rate for Payer: LLUH Dept of Risk Management WC $8.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS $11.60
Service Code NDC 0713-0655-40
Hospital Charge Code 1743376
Hospital Revenue Code 259
Min. Negotiated Rate $8.51
Max. Negotiated Rate $12.38
Rate for Payer: Cash Price $6.96
Rate for Payer: Cigna of CA HMO/PPO $12.38
Rate for Payer: Health Smart Auto/Commercial $9.28
Rate for Payer: LLUH Dept of Risk Management WC $8.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS $11.60
Service Code NDC 64980-320-05
Hospital Charge Code 1743376
Hospital Revenue Code 259
Min. Negotiated Rate $8.51
Max. Negotiated Rate $11.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $9.28
Rate for Payer: Aetna of CA Government/Medicare $9.28
Rate for Payer: Cash Price $6.96
Rate for Payer: Health Smart Auto/Commercial $9.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $9.28
Rate for Payer: LLUH Dept of Risk Management WC $8.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS $11.60
Service Code NDC 60432-561-60
Hospital Charge Code 1743378
Hospital Revenue Code 259
Min. Negotiated Rate $0.36
Max. Negotiated Rate $0.52
Rate for Payer: Cash Price $0.29
Rate for Payer: Cigna of CA HMO/PPO $0.52
Rate for Payer: Health Smart Auto/Commercial $0.39
Rate for Payer: LLUH Dept of Risk Management WC $0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.49
Service Code NDC 60432-561-60
Hospital Charge Code 1743378
Hospital Revenue Code 259
Min. Negotiated Rate $0.36
Max. Negotiated Rate $0.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.39
Rate for Payer: Aetna of CA Government/Medicare $0.39
Rate for Payer: Cash Price $0.29
Rate for Payer: Health Smart Auto/Commercial $0.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.39
Rate for Payer: LLUH Dept of Risk Management WC $0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.49
Service Code NDC 51672-1282-2
Hospital Charge Code NDG8113
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.20
Rate for Payer: Cash Price $0.11
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.19
Service Code NDC 33342-329-15
Hospital Charge Code 1743453
Hospital Revenue Code 259
Min. Negotiated Rate $0.16
Max. Negotiated Rate $0.23
Rate for Payer: Cash Price $0.13
Rate for Payer: Cigna of CA HMO/PPO $0.23
Rate for Payer: Health Smart Auto/Commercial $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.16
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.22
Service Code NDC 45802-064-05
Hospital Charge Code NDG8113B
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 $0.02
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 Beech St/Commercial/PHCS $0.04
Service Code NDC 45802-064-05
Hospital Charge Code NDG8113B
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.04
Rate for Payer: Cash Price $0.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS $0.04
Service Code NDC 51672-1282-2
Hospital Charge Code NDG8113
Hospital Revenue Code 259
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.19
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 $0.11
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 Beech St/Commercial/PHCS $0.19
Service Code NDC 67877-251-30
Hospital Charge Code NDG8113
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.19
Rate for Payer: Cash Price $0.11
Rate for Payer: Cigna of CA HMO/PPO $0.19
Rate for Payer: Health Smart Auto/Commercial $0.14
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.18
Service Code NDC 33342-329-15
Hospital Charge Code 1743453
Hospital Revenue Code 259
Min. Negotiated Rate $0.16
Max. Negotiated Rate $0.22
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 $0.13
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 Beech St/Commercial/PHCS $0.22
Service Code NDC 67877-251-45
Hospital Charge Code NDG8113B
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.05
Rate for Payer: Cash Price $0.03
Rate for Payer: Cigna of CA HMO/PPO $0.05
Rate for Payer: Health Smart Auto/Commercial $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.05
Service Code NDC 0168-0004-80
Hospital Charge Code 1743437
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.08
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 $0.05
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 $0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.08
Service Code NDC 67877-251-30
Hospital Charge Code NDG8113
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $0.14
Rate for Payer: Aetna of CA Government/Medicare $0.14
Rate for Payer: Cash Price $0.11
Rate for Payer: Health Smart Auto/Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $0.14
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS $0.18