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Service Code NDC 8398000501
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.16
Rate for Payer: Adventist Health Commercial $0.04
Rate for Payer: Aetna of CA Non-Gatekeeper $0.12
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.16
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.10
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.14
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.10
Rate for Payer: Blue Shield of California Commercial $0.12
Rate for Payer: Blue Shield of California EPN $0.09
Rate for Payer: Cash Price $0.09
Rate for Payer: Cigna of CA HMO/PPO $0.12
Rate for Payer: Dignity Health Commercial/Exchange $0.16
Rate for Payer: Dignity Health Medi-Cal $0.16
Rate for Payer: Dignity Health Medicare Advantage $0.16
Rate for Payer: EPIC Health Plan Commercial $0.12
Rate for Payer: Heritage Provider Network Commercial $0.12
Rate for Payer: Heritage Provider Network Senior $0.12
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.09
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.13
Rate for Payer: Multiplan Commercial $0.14
Rate for Payer: TriValley Medical Group Commercial $0.08
Rate for Payer: TriValley Medical Group Senior $0.08
Rate for Payer: United Healthcare All Other HMO/non HMO $0.10
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.10
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.16
Rate for Payer: Vantage Medical Group Medi-Cal $0.16
Rate for Payer: Vantage Medical Group Senior $0.16
Service Code HCPCS J1800
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $2.84
Max. Negotiated Rate $11.78
Rate for Payer: Adventist Health Commercial $3.14
Rate for Payer: Adventist Health Commercial $1.92
Rate for Payer: Aetna of CA Non-Gatekeeper $10.11
Rate for Payer: Aetna of CA Non-Gatekeeper $6.18
Rate for Payer: Cash Price $7.06
Rate for Payer: Cash Price $4.32
Rate for Payer: Cigna of CA HMO/PPO $7.22
Rate for Payer: Cigna of CA HMO/PPO $4.42
Rate for Payer: EPIC Health Plan Commercial $5.18
Rate for Payer: EPIC Health Plan Commercial $8.48
Rate for Payer: Heritage Provider Network Commercial $7.27
Rate for Payer: Heritage Provider Network Commercial $4.44
Rate for Payer: Heritage Provider Network Senior $4.44
Rate for Payer: Heritage Provider Network Senior $7.27
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $2.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $1.74
Rate for Payer: LLUH Dept of Risk Management WC $3.92
Rate for Payer: LLUH Dept of Risk Management WC $2.40
Rate for Payer: Multiplan Commercial $11.78
Rate for Payer: Multiplan Commercial $7.20
Rate for Payer: United Healthcare All Other HMO/non HMO $3.47
Rate for Payer: United Healthcare All Other HMO/non HMO $5.67
Rate for Payer: United Healthcare Navigate/Select/Select+ $3.18
Rate for Payer: United Healthcare Navigate/Select/Select+ $5.20
Service Code HCPCS J1800
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $2.84
Max. Negotiated Rate $21.53
Rate for Payer: Adventist Health Commercial $3.14
Rate for Payer: Adventist Health Commercial $1.92
Rate for Payer: Aetna of CA Non-Gatekeeper $5.93
Rate for Payer: Aetna of CA Non-Gatekeeper $9.70
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $13.35
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $8.16
Rate for Payer: Alpha Care Medical Group Medi-Cal $5.28
Rate for Payer: Alpha Care Medical Group Medi-Cal $8.63
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $11.78
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $7.20
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $21.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $21.53
Rate for Payer: Blue Shield of California Commercial $9.94
Rate for Payer: Blue Shield of California Commercial $9.94
Rate for Payer: Blue Shield of California EPN $9.94
Rate for Payer: Blue Shield of California EPN $9.94
Rate for Payer: Cash Price $7.06
Rate for Payer: Cash Price $4.32
Rate for Payer: Cash Price $7.06
Rate for Payer: Cash Price $4.32
Rate for Payer: Cigna of CA HMO/PPO $7.22
Rate for Payer: Cigna of CA HMO/PPO $4.42
Rate for Payer: Dignity Health Commercial/Exchange $13.35
Rate for Payer: Dignity Health Commercial/Exchange $8.16
Rate for Payer: Dignity Health Medi-Cal $8.16
Rate for Payer: Dignity Health Medi-Cal $13.35
Rate for Payer: Dignity Health Medicare Advantage $13.35
Rate for Payer: Dignity Health Medicare Advantage $8.16
Rate for Payer: EPIC Health Plan Commercial $10.05
Rate for Payer: EPIC Health Plan Commercial $6.14
Rate for Payer: Heritage Provider Network Commercial $4.44
Rate for Payer: Heritage Provider Network Commercial $7.27
Rate for Payer: Heritage Provider Network Senior $4.44
Rate for Payer: Heritage Provider Network Senior $7.27
Rate for Payer: Kaiser Foundation Hospitals Commercial $7.49
Rate for Payer: Kaiser Foundation Hospitals Commercial $4.58
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $1.74
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $2.84
Rate for Payer: LLUH Dept of Risk Management WC $2.40
Rate for Payer: LLUH Dept of Risk Management WC $3.92
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $6.72
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $10.99
Rate for Payer: Multiplan Commercial $7.20
Rate for Payer: Multiplan Commercial $11.78
Rate for Payer: TriValley Medical Group Commercial $6.28
Rate for Payer: TriValley Medical Group Commercial $3.84
Rate for Payer: TriValley Medical Group Senior $6.28
Rate for Payer: TriValley Medical Group Senior $3.84
Rate for Payer: United Healthcare All Other HMO/non HMO $5.67
Rate for Payer: United Healthcare All Other HMO/non HMO $3.47
Rate for Payer: United Healthcare Navigate/Select/Select+ $3.18
Rate for Payer: United Healthcare Navigate/Select/Select+ $5.20
Rate for Payer: Vantage Medical Group Commercial/Exchange $8.16
Rate for Payer: Vantage Medical Group Commercial/Exchange $13.35
Rate for Payer: Vantage Medical Group Medi-Cal $13.35
Rate for Payer: Vantage Medical Group Medi-Cal $8.16
Rate for Payer: Vantage Medical Group Senior $8.16
Rate for Payer: Vantage Medical Group Senior $13.35
Service Code NDC 0054372763
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.09
Rate for Payer: Adventist Health Commercial $0.02
Rate for Payer: Aetna of CA Non-Gatekeeper $0.08
Rate for Payer: Cash Price $0.05
Rate for Payer: EPIC Health Plan Commercial $0.06
Rate for Payer: Heritage Provider Network Commercial $0.08
Rate for Payer: Heritage Provider Network Senior $0.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.09
Service Code NDC 0054372763
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.10
Rate for Payer: Adventist Health Commercial $0.02
Rate for Payer: Aetna of CA Non-Gatekeeper $0.07
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.10
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.07
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.09
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.06
Rate for Payer: Blue Shield of California Commercial $0.07
Rate for Payer: Blue Shield of California EPN $0.06
Rate for Payer: Cash Price $0.05
Rate for Payer: Cigna of CA HMO/PPO $0.08
Rate for Payer: Dignity Health Commercial/Exchange $0.10
Rate for Payer: Dignity Health Medi-Cal $0.10
Rate for Payer: Dignity Health Medicare Advantage $0.10
Rate for Payer: EPIC Health Plan Commercial $0.08
Rate for Payer: Heritage Provider Network Commercial $0.07
Rate for Payer: Heritage Provider Network Senior $0.07
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.06
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.08
Rate for Payer: Multiplan Commercial $0.09
Rate for Payer: TriValley Medical Group Commercial $0.05
Rate for Payer: TriValley Medical Group Senior $0.05
Rate for Payer: United Healthcare All Other HMO/non HMO $0.06
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.06
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.10
Rate for Payer: Vantage Medical Group Medi-Cal $0.10
Rate for Payer: Vantage Medical Group Senior $0.10
Service Code NDC 6923820787
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: Aetna of CA Non-Gatekeeper $0.15
Rate for Payer: Cash Price $0.11
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 Foundation Hospitals 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 6923820781
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: Aetna of CA Non-Gatekeeper $0.15
Rate for Payer: Cash Price $0.11
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 Foundation Hospitals 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 0603548321
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 Non-Gatekeeper $0.15
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: Anthem Blue Cross of CA HMO/PPO $0.12
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 $0.11
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 Medicare Advantage $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 Foundation Hospitals Commercial $0.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Molina Healthcare of CA Medi-Cal/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 0603548321
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: Aetna of CA Non-Gatekeeper $0.15
Rate for Payer: Cash Price $0.11
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 Foundation Hospitals 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 0591555501
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.31
Rate for Payer: Adventist Health Commercial $0.08
Rate for Payer: Aetna of CA Non-Gatekeeper $0.26
Rate for Payer: Cash Price $0.18
Rate for Payer: EPIC Health Plan Commercial $0.22
Rate for Payer: Heritage Provider Network Commercial $0.28
Rate for Payer: Heritage Provider Network Senior $0.28
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.10
Rate for Payer: Multiplan Commercial $0.31
Service Code NDC 6923820781
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 Non-Gatekeeper $0.15
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: Anthem Blue Cross of CA HMO/PPO $0.12
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 $0.11
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 Medicare Advantage $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 Foundation Hospitals Commercial $0.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Molina Healthcare of CA Medi-Cal/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 6923820787
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 Non-Gatekeeper $0.15
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: Anthem Blue Cross of CA HMO/PPO $0.12
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 $0.11
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 Medicare Advantage $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 Foundation Hospitals Commercial $0.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.04
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Molina Healthcare of CA Medi-Cal/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 0591555501
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.35
Rate for Payer: Adventist Health Commercial $0.08
Rate for Payer: Aetna of CA Non-Gatekeeper $0.25
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.35
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.23
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.31
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.21
Rate for Payer: Blue Shield of California Commercial $0.25
Rate for Payer: Blue Shield of California EPN $0.20
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA HMO/PPO $0.27
Rate for Payer: Dignity Health Commercial/Exchange $0.35
Rate for Payer: Dignity Health Medi-Cal $0.35
Rate for Payer: Dignity Health Medicare Advantage $0.35
Rate for Payer: EPIC Health Plan Commercial $0.26
Rate for Payer: Heritage Provider Network Commercial $0.25
Rate for Payer: Heritage Provider Network Senior $0.25
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.10
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.29
Rate for Payer: Multiplan Commercial $0.31
Rate for Payer: TriValley Medical Group Commercial $0.16
Rate for Payer: TriValley Medical Group Senior $0.16
Rate for Payer: United Healthcare All Other HMO/non HMO $0.21
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.21
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.35
Rate for Payer: Vantage Medical Group Medi-Cal $0.35
Rate for Payer: Vantage Medical Group Senior $0.35
Service Code NDC 0603548421
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.26
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.26
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.17
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.15
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.15
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO/PPO $0.20
Rate for Payer: Dignity Health Commercial/Exchange $0.26
Rate for Payer: Dignity Health Medi-Cal $0.26
Rate for Payer: Dignity Health Medicare Advantage $0.26
Rate for Payer: EPIC Health Plan Commercial $0.19
Rate for Payer: Heritage Provider Network Commercial $0.19
Rate for Payer: Heritage Provider Network Senior $0.19
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.14
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.21
Rate for Payer: Multiplan Commercial $0.23
Rate for Payer: TriValley Medical Group Commercial $0.12
Rate for Payer: TriValley Medical Group Senior $0.12
Rate for Payer: United Healthcare All Other HMO/non HMO $0.15
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.15
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.26
Rate for Payer: Vantage Medical Group Medi-Cal $0.26
Rate for Payer: Vantage Medical Group Senior $0.26
Service Code NDC 6923820797
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.23
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Cash Price $0.14
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: Heritage Provider Network Commercial $0.20
Rate for Payer: Heritage Provider Network Senior $0.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 2315511210
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.26
Rate for Payer: Vantage Medical Group Medi-Cal $0.26
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.26
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.17
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.15
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.15
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO/PPO $0.20
Rate for Payer: Dignity Health Commercial/Exchange $0.26
Rate for Payer: Dignity Health Medi-Cal $0.26
Rate for Payer: Dignity Health Medicare Advantage $0.26
Rate for Payer: EPIC Health Plan Commercial $0.19
Rate for Payer: Heritage Provider Network Commercial $0.19
Rate for Payer: Heritage Provider Network Senior $0.19
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.14
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.21
Rate for Payer: Multiplan Commercial $0.23
Rate for Payer: TriValley Medical Group Commercial $0.12
Rate for Payer: TriValley Medical Group Senior $0.12
Rate for Payer: United Healthcare All Other HMO/non HMO $0.15
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.15
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.26
Rate for Payer: Vantage Medical Group Senior $0.26
Service Code NDC 0591555601
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.49
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Aetna of CA Non-Gatekeeper $0.36
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.49
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.32
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.44
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.29
Rate for Payer: Blue Shield of California Commercial $0.35
Rate for Payer: Blue Shield of California EPN $0.28
Rate for Payer: Cash Price $0.26
Rate for Payer: Cigna of CA HMO/PPO $0.38
Rate for Payer: Dignity Health Commercial/Exchange $0.49
Rate for Payer: Dignity Health Medi-Cal $0.49
Rate for Payer: Dignity Health Medicare Advantage $0.49
Rate for Payer: EPIC Health Plan Commercial $0.37
Rate for Payer: Heritage Provider Network Commercial $0.36
Rate for Payer: Heritage Provider Network Senior $0.36
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.28
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.41
Rate for Payer: Multiplan Commercial $0.44
Rate for Payer: TriValley Medical Group Commercial $0.23
Rate for Payer: TriValley Medical Group Senior $0.23
Rate for Payer: United Healthcare All Other HMO/non HMO $0.29
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.29
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.49
Rate for Payer: Vantage Medical Group Medi-Cal $0.49
Rate for Payer: Vantage Medical Group Senior $0.49
Service Code NDC 0603548421
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.23
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Cash Price $0.14
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: Heritage Provider Network Commercial $0.20
Rate for Payer: Heritage Provider Network Senior $0.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 6923820797
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.26
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.26
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.17
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.15
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.15
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO/PPO $0.20
Rate for Payer: Dignity Health Commercial/Exchange $0.26
Rate for Payer: Dignity Health Medi-Cal $0.26
Rate for Payer: Dignity Health Medicare Advantage $0.26
Rate for Payer: EPIC Health Plan Commercial $0.19
Rate for Payer: Heritage Provider Network Commercial $0.19
Rate for Payer: Heritage Provider Network Senior $0.19
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.14
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.21
Rate for Payer: Multiplan Commercial $0.23
Rate for Payer: TriValley Medical Group Commercial $0.12
Rate for Payer: TriValley Medical Group Senior $0.12
Rate for Payer: United Healthcare All Other HMO/non HMO $0.15
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.15
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.26
Rate for Payer: Vantage Medical Group Medi-Cal $0.26
Rate for Payer: Vantage Medical Group Senior $0.26
Service Code NDC 0603548432
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.23
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Cash Price $0.14
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: Heritage Provider Network Commercial $0.20
Rate for Payer: Heritage Provider Network Senior $0.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 6923820791
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.23
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Cash Price $0.14
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: Heritage Provider Network Commercial $0.20
Rate for Payer: Heritage Provider Network Senior $0.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.23
Service Code NDC 0591555601
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.44
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Aetna of CA Non-Gatekeeper $0.37
Rate for Payer: Cash Price $0.26
Rate for Payer: EPIC Health Plan Commercial $0.31
Rate for Payer: Heritage Provider Network Commercial $0.39
Rate for Payer: Heritage Provider Network Senior $0.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.44
Service Code NDC 0378018401
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.51
Rate for Payer: Adventist Health Commercial $0.12
Rate for Payer: Aetna of CA Non-Gatekeeper $0.37
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.51
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.33
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.45
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.30
Rate for Payer: Blue Shield of California Commercial $0.37
Rate for Payer: Blue Shield of California EPN $0.29
Rate for Payer: Cash Price $0.27
Rate for Payer: Cigna of CA HMO/PPO $0.39
Rate for Payer: Dignity Health Commercial/Exchange $0.51
Rate for Payer: Dignity Health Medi-Cal $0.51
Rate for Payer: Dignity Health Medicare Advantage $0.51
Rate for Payer: EPIC Health Plan Commercial $0.38
Rate for Payer: Heritage Provider Network Commercial $0.37
Rate for Payer: Heritage Provider Network Senior $0.37
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.29
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.42
Rate for Payer: Multiplan Commercial $0.45
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 $0.30
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.30
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.51
Rate for Payer: Vantage Medical Group Medi-Cal $0.51
Rate for Payer: Vantage Medical Group Senior $0.51
Service Code NDC 6929253401
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.26
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.26
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.17
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.16
Rate for Payer: Blue Shield of California Commercial $0.19
Rate for Payer: Blue Shield of California EPN $0.15
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO/PPO $0.20
Rate for Payer: Dignity Health Commercial/Exchange $0.26
Rate for Payer: Dignity Health Medi-Cal $0.26
Rate for Payer: Dignity Health Medicare Advantage $0.26
Rate for Payer: EPIC Health Plan Commercial $0.20
Rate for Payer: Heritage Provider Network Commercial $0.19
Rate for Payer: Heritage Provider Network Senior $0.19
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.15
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.06
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.22
Rate for Payer: Multiplan Commercial $0.23
Rate for Payer: TriValley Medical Group Commercial $0.12
Rate for Payer: TriValley Medical Group Senior $0.12
Rate for Payer: United Healthcare All Other HMO/non HMO $0.16
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.16
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.26
Rate for Payer: Vantage Medical Group Medi-Cal $0.26
Rate for Payer: Vantage Medical Group Senior $0.26
Service Code NDC 6929253401
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.23
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.20
Rate for Payer: Cash Price $0.14
Rate for Payer: EPIC Health Plan Commercial $0.17
Rate for Payer: Heritage Provider Network Commercial $0.21
Rate for Payer: Heritage Provider Network Senior $0.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.06
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.23