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Service Code NDC 68382-114-14
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.14
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Aetna of CA Gatekeeper $0.09
Rate for Payer: Aetna of CA Non-Gatekeeper $0.11
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.14
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.09
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.12
Rate for Payer: Blue Shield of California Commercial $0.10
Rate for Payer: Blue Shield of California EPN $0.08
Rate for Payer: Cash Price $0.09
Rate for Payer: Cigna of CA HMO/PPO $0.10
Rate for Payer: Dignity Health Commercial/Exchange $0.14
Rate for Payer: Dignity Health Medi-Cal $0.14
Rate for Payer: Dignity Health Senior $0.14
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Heritage Provider Network Commercial $0.10
Rate for Payer: Heritage Provider Network Senior $0.10
Rate for Payer: Kaiser Permanente of CA Commercial $0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.04
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.11
Rate for Payer: Molina Healthcare of CA Medicare $0.11
Rate for Payer: Multiplan Commercial $0.12
Rate for Payer: TriValley Medical Group Commercial $0.06
Rate for Payer: TriValley Medical Group Senior $0.06
Rate for Payer: United Healthcare All Other HMO/non HMO $0.08
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.08
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.14
Rate for Payer: Vantage Medical Group Medi-Cal $0.14
Rate for Payer: Vantage Medical Group Senior $0.14
Service Code NDC 68382-114-14
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.12
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Cash Price $0.09
Rate for Payer: EPIC Health Plan Commercial $0.09
Rate for Payer: Heritage Provider Network Commercial $0.11
Rate for Payer: Heritage Provider Network Senior $0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.04
Rate for Payer: Multiplan Commercial $0.12
Service Code NDC 68084-272-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.43
Rate for Payer: Adventist Health Commercial $0.10
Rate for Payer: Aetna of CA Gatekeeper $0.27
Rate for Payer: Aetna of CA Non-Gatekeeper $0.34
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.43
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.28
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.38
Rate for Payer: Blue Shield of California Commercial $0.31
Rate for Payer: Blue Shield of California EPN $0.24
Rate for Payer: Cash Price $0.28
Rate for Payer: Cigna of CA HMO/PPO $0.33
Rate for Payer: Dignity Health Commercial/Exchange $0.43
Rate for Payer: Dignity Health Medi-Cal $0.43
Rate for Payer: Dignity Health Senior $0.43
Rate for Payer: EPIC Health Plan Commercial $0.32
Rate for Payer: Heritage Provider Network Commercial $0.31
Rate for Payer: Heritage Provider Network Senior $0.31
Rate for Payer: Kaiser Permanente of CA Commercial $0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.35
Rate for Payer: Molina Healthcare of CA Medicare $0.35
Rate for Payer: Multiplan Commercial $0.38
Rate for Payer: TriValley Medical Group Commercial $0.20
Rate for Payer: TriValley Medical Group Senior $0.20
Rate for Payer: United Healthcare All Other HMO/non HMO $0.25
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.25
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.43
Rate for Payer: Vantage Medical Group Medi-Cal $0.43
Rate for Payer: Vantage Medical Group Senior $0.43
Service Code NDC 68084-272-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.38
Rate for Payer: Adventist Health Commercial $0.10
Rate for Payer: Cash Price $0.28
Rate for Payer: EPIC Health Plan Commercial $0.27
Rate for Payer: Heritage Provider Network Commercial $0.34
Rate for Payer: Heritage Provider Network Senior $0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.38
Service Code NDC 68084-272-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.43
Rate for Payer: Adventist Health Commercial $0.10
Rate for Payer: Aetna of CA Gatekeeper $0.27
Rate for Payer: Aetna of CA Non-Gatekeeper $0.34
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.43
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.28
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.38
Rate for Payer: Blue Shield of California Commercial $0.31
Rate for Payer: Blue Shield of California EPN $0.24
Rate for Payer: Cash Price $0.28
Rate for Payer: Cigna of CA HMO/PPO $0.33
Rate for Payer: Dignity Health Commercial/Exchange $0.43
Rate for Payer: Dignity Health Medi-Cal $0.43
Rate for Payer: Dignity Health Senior $0.43
Rate for Payer: EPIC Health Plan Commercial $0.32
Rate for Payer: Heritage Provider Network Commercial $0.31
Rate for Payer: Heritage Provider Network Senior $0.31
Rate for Payer: Kaiser Permanente of CA Commercial $0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.35
Rate for Payer: Molina Healthcare of CA Medicare $0.35
Rate for Payer: Multiplan Commercial $0.38
Rate for Payer: TriValley Medical Group Commercial $0.20
Rate for Payer: TriValley Medical Group Senior $0.20
Rate for Payer: United Healthcare All Other HMO/non HMO $0.25
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.25
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.43
Rate for Payer: Vantage Medical Group Medi-Cal $0.43
Rate for Payer: Vantage Medical Group Senior $0.43
Service Code NDC 68084-272-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.38
Rate for Payer: Adventist Health Commercial $0.10
Rate for Payer: Cash Price $0.28
Rate for Payer: EPIC Health Plan Commercial $0.27
Rate for Payer: Heritage Provider Network Commercial $0.34
Rate for Payer: Heritage Provider Network Senior $0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.38
Service Code NDC 43547-341-06
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.18
Rate for Payer: Adventist Health Commercial $0.05
Rate for Payer: Cash Price $0.13
Rate for Payer: EPIC Health Plan Commercial $0.13
Rate for Payer: Heritage Provider Network Commercial $0.16
Rate for Payer: Heritage Provider Network Senior $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.18
Service Code NDC 43547-341-06
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.20
Rate for Payer: Adventist Health Commercial $0.05
Rate for Payer: Aetna of CA Gatekeeper $0.13
Rate for Payer: Aetna of CA Non-Gatekeeper $0.16
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.20
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.13
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.18
Rate for Payer: Blue Shield of California Commercial $0.15
Rate for Payer: Blue Shield of California EPN $0.12
Rate for Payer: Cash Price $0.13
Rate for Payer: Cigna of CA HMO/PPO $0.16
Rate for Payer: Dignity Health Commercial/Exchange $0.20
Rate for Payer: Dignity Health Medi-Cal $0.20
Rate for Payer: Dignity Health Senior $0.20
Rate for Payer: EPIC Health Plan Commercial $0.15
Rate for Payer: Heritage Provider Network Commercial $0.15
Rate for Payer: Heritage Provider Network Senior $0.15
Rate for Payer: Kaiser Permanente of CA Commercial $0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.17
Rate for Payer: Molina Healthcare of CA Medicare $0.17
Rate for Payer: Multiplan Commercial $0.18
Rate for Payer: TriValley Medical Group Commercial $0.10
Rate for Payer: TriValley Medical Group Senior $0.10
Rate for Payer: United Healthcare All Other HMO/non HMO $0.12
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.12
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.20
Rate for Payer: Vantage Medical Group Medi-Cal $0.20
Rate for Payer: Vantage Medical Group Senior $0.20
Service Code NDC 59746-030-22
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.73
Max. Negotiated Rate $3.01
Rate for Payer: Adventist Health Commercial $0.80
Rate for Payer: Cash Price $2.20
Rate for Payer: EPIC Health Plan Commercial $2.17
Rate for Payer: Heritage Provider Network Commercial $2.71
Rate for Payer: Heritage Provider Network Senior $2.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.73
Rate for Payer: LLUH Dept of Risk Management WC $1.00
Rate for Payer: Multiplan Commercial $3.01
Service Code NDC 49884-401-91
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.44
Max. Negotiated Rate $5.98
Rate for Payer: Adventist Health Commercial $1.59
Rate for Payer: Cash Price $4.38
Rate for Payer: EPIC Health Plan Commercial $4.30
Rate for Payer: Heritage Provider Network Commercial $5.40
Rate for Payer: Heritage Provider Network Senior $5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.44
Rate for Payer: LLUH Dept of Risk Management WC $1.99
Rate for Payer: Multiplan Commercial $5.98
Service Code NDC 59746-030-22
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.73
Max. Negotiated Rate $3.41
Rate for Payer: Adventist Health Commercial $0.80
Rate for Payer: Aetna of CA Gatekeeper $2.14
Rate for Payer: Aetna of CA Non-Gatekeeper $2.75
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $3.41
Rate for Payer: Alpha Care Medical Group Medi-Cal $2.21
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $3.01
Rate for Payer: Blue Shield of California Commercial $2.45
Rate for Payer: Blue Shield of California EPN $1.96
Rate for Payer: Cash Price $2.20
Rate for Payer: Cigna of CA HMO/PPO $2.61
Rate for Payer: Dignity Health Commercial/Exchange $3.41
Rate for Payer: Dignity Health Medi-Cal $3.41
Rate for Payer: Dignity Health Senior $3.41
Rate for Payer: EPIC Health Plan Commercial $2.57
Rate for Payer: Heritage Provider Network Commercial $2.48
Rate for Payer: Heritage Provider Network Senior $2.48
Rate for Payer: Kaiser Permanente of CA Commercial $1.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.73
Rate for Payer: LLUH Dept of Risk Management WC $1.00
Rate for Payer: Molina Healthcare of CA Medi-Cal $2.81
Rate for Payer: Molina Healthcare of CA Medicare $2.81
Rate for Payer: Multiplan Commercial $3.01
Rate for Payer: TriValley Medical Group Commercial $1.60
Rate for Payer: TriValley Medical Group Senior $1.60
Rate for Payer: United Healthcare All Other HMO/non HMO $2.00
Rate for Payer: United Healthcare Navigate/Select/Select+ $2.00
Rate for Payer: Vantage Medical Group Commercial/Exchange $3.41
Rate for Payer: Vantage Medical Group Medi-Cal $3.41
Rate for Payer: Vantage Medical Group Senior $3.41
Service Code NDC 49884-401-91
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.44
Max. Negotiated Rate $6.77
Rate for Payer: Adventist Health Commercial $1.59
Rate for Payer: Aetna of CA Gatekeeper $4.26
Rate for Payer: Aetna of CA Non-Gatekeeper $5.48
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $6.77
Rate for Payer: Alpha Care Medical Group Medi-Cal $4.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $5.98
Rate for Payer: Blue Shield of California Commercial $4.86
Rate for Payer: Blue Shield of California EPN $3.89
Rate for Payer: Cash Price $4.38
Rate for Payer: Cigna of CA HMO/PPO $5.18
Rate for Payer: Dignity Health Commercial/Exchange $6.77
Rate for Payer: Dignity Health Medi-Cal $6.77
Rate for Payer: Dignity Health Senior $6.77
Rate for Payer: EPIC Health Plan Commercial $5.10
Rate for Payer: Heritage Provider Network Commercial $4.93
Rate for Payer: Heritage Provider Network Senior $4.93
Rate for Payer: Kaiser Permanente of CA Commercial $3.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.44
Rate for Payer: LLUH Dept of Risk Management WC $1.99
Rate for Payer: Molina Healthcare of CA Medi-Cal $5.58
Rate for Payer: Molina Healthcare of CA Medicare $5.58
Rate for Payer: Multiplan Commercial $5.98
Rate for Payer: TriValley Medical Group Commercial $3.19
Rate for Payer: TriValley Medical Group Senior $3.19
Rate for Payer: United Healthcare All Other HMO/non HMO $3.98
Rate for Payer: United Healthcare Navigate/Select/Select+ $3.98
Rate for Payer: Vantage Medical Group Commercial/Exchange $6.77
Rate for Payer: Vantage Medical Group Medi-Cal $6.77
Rate for Payer: Vantage Medical Group Senior $6.77
Service Code NDC 49884-401-52
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.44
Max. Negotiated Rate $5.98
Rate for Payer: Adventist Health Commercial $1.59
Rate for Payer: Cash Price $4.38
Rate for Payer: EPIC Health Plan Commercial $4.30
Rate for Payer: Heritage Provider Network Commercial $5.40
Rate for Payer: Heritage Provider Network Senior $5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.44
Rate for Payer: LLUH Dept of Risk Management WC $1.99
Rate for Payer: Multiplan Commercial $5.98
Service Code NDC 49884-401-52
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $1.44
Max. Negotiated Rate $6.77
Rate for Payer: Adventist Health Commercial $1.59
Rate for Payer: Aetna of CA Gatekeeper $4.26
Rate for Payer: Aetna of CA Non-Gatekeeper $5.48
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $6.77
Rate for Payer: Alpha Care Medical Group Medi-Cal $4.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $5.98
Rate for Payer: Blue Shield of California Commercial $4.86
Rate for Payer: Blue Shield of California EPN $3.89
Rate for Payer: Cash Price $4.38
Rate for Payer: Cigna of CA HMO/PPO $5.18
Rate for Payer: Dignity Health Commercial/Exchange $6.77
Rate for Payer: Dignity Health Medi-Cal $6.77
Rate for Payer: Dignity Health Senior $6.77
Rate for Payer: EPIC Health Plan Commercial $5.10
Rate for Payer: Heritage Provider Network Commercial $4.93
Rate for Payer: Heritage Provider Network Senior $4.93
Rate for Payer: Kaiser Permanente of CA Commercial $3.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.44
Rate for Payer: LLUH Dept of Risk Management WC $1.99
Rate for Payer: Molina Healthcare of CA Medi-Cal $5.58
Rate for Payer: Molina Healthcare of CA Medicare $5.58
Rate for Payer: Multiplan Commercial $5.98
Rate for Payer: TriValley Medical Group Commercial $3.19
Rate for Payer: TriValley Medical Group Senior $3.19
Rate for Payer: United Healthcare All Other HMO/non HMO $3.98
Rate for Payer: United Healthcare Navigate/Select/Select+ $3.98
Rate for Payer: Vantage Medical Group Commercial/Exchange $6.77
Rate for Payer: Vantage Medical Group Medi-Cal $6.77
Rate for Payer: Vantage Medical Group Senior $6.77
Service Code NDC 68084-274-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.52
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Aetna of CA Gatekeeper $0.33
Rate for Payer: Aetna of CA Non-Gatekeeper $0.42
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.52
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.34
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.46
Rate for Payer: Blue Shield of California Commercial $0.37
Rate for Payer: Blue Shield of California EPN $0.30
Rate for Payer: Cash Price $0.33
Rate for Payer: Cigna of CA HMO/PPO $0.40
Rate for Payer: Dignity Health Commercial/Exchange $0.52
Rate for Payer: Dignity Health Medi-Cal $0.52
Rate for Payer: Dignity Health Senior $0.52
Rate for Payer: EPIC Health Plan Commercial $0.39
Rate for Payer: Heritage Provider Network Commercial $0.38
Rate for Payer: Heritage Provider Network Senior $0.38
Rate for Payer: Kaiser Permanente of CA Commercial $0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.43
Rate for Payer: Molina Healthcare of CA Medicare $0.43
Rate for Payer: Multiplan Commercial $0.46
Rate for Payer: TriValley Medical Group Commercial $0.24
Rate for Payer: TriValley Medical Group Senior $0.24
Rate for Payer: United Healthcare All Other HMO/non HMO $0.31
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.31
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.52
Rate for Payer: Vantage Medical Group Medi-Cal $0.52
Rate for Payer: Vantage Medical Group Senior $0.52
Service Code NDC 68084-274-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.46
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Cash Price $0.33
Rate for Payer: EPIC Health Plan Commercial $0.33
Rate for Payer: Heritage Provider Network Commercial $0.41
Rate for Payer: Heritage Provider Network Senior $0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.46
Service Code NDC 68084-274-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.52
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Aetna of CA Gatekeeper $0.33
Rate for Payer: Aetna of CA Non-Gatekeeper $0.42
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.52
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.34
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.46
Rate for Payer: Blue Shield of California Commercial $0.37
Rate for Payer: Blue Shield of California EPN $0.30
Rate for Payer: Cash Price $0.33
Rate for Payer: Cigna of CA HMO/PPO $0.40
Rate for Payer: Dignity Health Commercial/Exchange $0.52
Rate for Payer: Dignity Health Medi-Cal $0.52
Rate for Payer: Dignity Health Senior $0.52
Rate for Payer: EPIC Health Plan Commercial $0.39
Rate for Payer: Heritage Provider Network Commercial $0.38
Rate for Payer: Heritage Provider Network Senior $0.38
Rate for Payer: Kaiser Permanente of CA Commercial $0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.43
Rate for Payer: Molina Healthcare of CA Medicare $0.43
Rate for Payer: Multiplan Commercial $0.46
Rate for Payer: TriValley Medical Group Commercial $0.24
Rate for Payer: TriValley Medical Group Senior $0.24
Rate for Payer: United Healthcare All Other HMO/non HMO $0.31
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.31
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.52
Rate for Payer: Vantage Medical Group Medi-Cal $0.52
Rate for Payer: Vantage Medical Group Senior $0.52
Service Code NDC 68084-274-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.46
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Cash Price $0.33
Rate for Payer: EPIC Health Plan Commercial $0.33
Rate for Payer: Heritage Provider Network Commercial $0.41
Rate for Payer: Heritage Provider Network Senior $0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.46
Service Code NDC 68084-277-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.52
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Aetna of CA Gatekeeper $0.33
Rate for Payer: Aetna of CA Non-Gatekeeper $0.42
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.52
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.34
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.46
Rate for Payer: Blue Shield of California Commercial $0.37
Rate for Payer: Blue Shield of California EPN $0.30
Rate for Payer: Cash Price $0.33
Rate for Payer: Cigna of CA HMO/PPO $0.40
Rate for Payer: Dignity Health Commercial/Exchange $0.52
Rate for Payer: Dignity Health Medi-Cal $0.52
Rate for Payer: Dignity Health Senior $0.52
Rate for Payer: EPIC Health Plan Commercial $0.39
Rate for Payer: Heritage Provider Network Commercial $0.38
Rate for Payer: Heritage Provider Network Senior $0.38
Rate for Payer: Kaiser Permanente of CA Commercial $0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.43
Rate for Payer: Molina Healthcare of CA Medicare $0.43
Rate for Payer: Multiplan Commercial $0.46
Rate for Payer: TriValley Medical Group Commercial $0.24
Rate for Payer: TriValley Medical Group Senior $0.24
Rate for Payer: United Healthcare All Other HMO/non HMO $0.31
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.31
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.52
Rate for Payer: Vantage Medical Group Medi-Cal $0.52
Rate for Payer: Vantage Medical Group Senior $0.52
Service Code NDC 68084-277-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.46
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Cash Price $0.33
Rate for Payer: EPIC Health Plan Commercial $0.33
Rate for Payer: Heritage Provider Network Commercial $0.41
Rate for Payer: Heritage Provider Network Senior $0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.46
Service Code NDC 68084-277-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.46
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Cash Price $0.33
Rate for Payer: EPIC Health Plan Commercial $0.33
Rate for Payer: Heritage Provider Network Commercial $0.41
Rate for Payer: Heritage Provider Network Senior $0.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.46
Service Code NDC 68084-277-11
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.52
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Aetna of CA Gatekeeper $0.33
Rate for Payer: Aetna of CA Non-Gatekeeper $0.42
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.52
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.34
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.46
Rate for Payer: Blue Shield of California Commercial $0.37
Rate for Payer: Blue Shield of California EPN $0.30
Rate for Payer: Cash Price $0.33
Rate for Payer: Cigna of CA HMO/PPO $0.40
Rate for Payer: Dignity Health Commercial/Exchange $0.52
Rate for Payer: Dignity Health Medi-Cal $0.52
Rate for Payer: Dignity Health Senior $0.52
Rate for Payer: EPIC Health Plan Commercial $0.39
Rate for Payer: Heritage Provider Network Commercial $0.38
Rate for Payer: Heritage Provider Network Senior $0.38
Rate for Payer: Kaiser Permanente of CA Commercial $0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.43
Rate for Payer: Molina Healthcare of CA Medicare $0.43
Rate for Payer: Multiplan Commercial $0.46
Rate for Payer: TriValley Medical Group Commercial $0.24
Rate for Payer: TriValley Medical Group Senior $0.24
Rate for Payer: United Healthcare All Other HMO/non HMO $0.31
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.31
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.52
Rate for Payer: Vantage Medical Group Medi-Cal $0.52
Rate for Payer: Vantage Medical Group Senior $0.52
Service Code NDC 0069-0334-28
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $32.24
Max. Negotiated Rate $151.38
Rate for Payer: Adventist Health Commercial $35.62
Rate for Payer: Aetna of CA Gatekeeper $95.19
Rate for Payer: Aetna of CA Non-Gatekeeper $122.35
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $151.38
Rate for Payer: Alpha Care Medical Group Medi-Cal $97.95
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $133.57
Rate for Payer: Blue Shield of California Commercial $108.64
Rate for Payer: Blue Shield of California EPN $86.91
Rate for Payer: Cash Price $97.95
Rate for Payer: Cigna of CA HMO/PPO $115.77
Rate for Payer: Dignity Health Commercial/Exchange $151.38
Rate for Payer: Dignity Health Medi-Cal $151.38
Rate for Payer: Dignity Health Senior $151.38
Rate for Payer: EPIC Health Plan Commercial $113.98
Rate for Payer: Heritage Provider Network Commercial $110.24
Rate for Payer: Heritage Provider Network Senior $110.24
Rate for Payer: Kaiser Permanente of CA Commercial $84.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal $32.24
Rate for Payer: LLUH Dept of Risk Management WC $44.52
Rate for Payer: Molina Healthcare of CA Medi-Cal $124.67
Rate for Payer: Molina Healthcare of CA Medicare $124.67
Rate for Payer: Multiplan Commercial $133.57
Rate for Payer: TriValley Medical Group Commercial $71.24
Rate for Payer: TriValley Medical Group Senior $71.24
Rate for Payer: United Healthcare All Other HMO/non HMO $89.05
Rate for Payer: United Healthcare Navigate/Select/Select+ $89.05
Rate for Payer: Vantage Medical Group Commercial/Exchange $151.38
Rate for Payer: Vantage Medical Group Medi-Cal $151.38
Rate for Payer: Vantage Medical Group Senior $151.38
Service Code NDC 0069-0334-28
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $32.24
Max. Negotiated Rate $133.57
Rate for Payer: Adventist Health Commercial $35.62
Rate for Payer: Cash Price $97.95
Rate for Payer: EPIC Health Plan Commercial $96.17
Rate for Payer: Heritage Provider Network Commercial $120.57
Rate for Payer: Heritage Provider Network Senior $120.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal $32.24
Rate for Payer: LLUH Dept of Risk Management WC $44.52
Rate for Payer: Multiplan Commercial $133.57
Service Code NDC 31722-597-30
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.58
Max. Negotiated Rate $2.72
Rate for Payer: Adventist Health Commercial $0.64
Rate for Payer: Aetna of CA Gatekeeper $1.71
Rate for Payer: Aetna of CA Non-Gatekeeper $2.20
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $2.72
Rate for Payer: Alpha Care Medical Group Medi-Cal $1.76
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $2.40
Rate for Payer: Blue Shield of California Commercial $1.95
Rate for Payer: Blue Shield of California EPN $1.56
Rate for Payer: Cash Price $1.76
Rate for Payer: Cigna of CA HMO/PPO $2.08
Rate for Payer: Dignity Health Commercial/Exchange $2.72
Rate for Payer: Dignity Health Medi-Cal $2.72
Rate for Payer: Dignity Health Senior $2.72
Rate for Payer: EPIC Health Plan Commercial $2.05
Rate for Payer: Heritage Provider Network Commercial $1.98
Rate for Payer: Heritage Provider Network Senior $1.98
Rate for Payer: Kaiser Permanente of CA Commercial $1.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.58
Rate for Payer: LLUH Dept of Risk Management WC $0.80
Rate for Payer: Molina Healthcare of CA Medi-Cal $2.24
Rate for Payer: Molina Healthcare of CA Medicare $2.24
Rate for Payer: Multiplan Commercial $2.40
Rate for Payer: TriValley Medical Group Commercial $1.28
Rate for Payer: TriValley Medical Group Senior $1.28
Rate for Payer: United Healthcare All Other HMO/non HMO $1.60
Rate for Payer: United Healthcare Navigate/Select/Select+ $1.60
Rate for Payer: Vantage Medical Group Commercial/Exchange $2.72
Rate for Payer: Vantage Medical Group Medi-Cal $2.72
Rate for Payer: Vantage Medical Group Senior $2.72