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Service Code NDC 61314-044-75
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $5.68
Max. Negotiated Rate $26.66
Rate for Payer: Adventist Health Commercial $6.27
Rate for Payer: Aetna of CA Gatekeeper $16.76
Rate for Payer: Aetna of CA Non-Gatekeeper $21.54
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $26.66
Rate for Payer: Alpha Care Medical Group Medi-Cal $17.25
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $23.52
Rate for Payer: Blue Shield of California Commercial $19.13
Rate for Payer: Blue Shield of California EPN $15.30
Rate for Payer: Cash Price $17.25
Rate for Payer: Cigna of CA HMO/PPO $20.38
Rate for Payer: Dignity Health Commercial/Exchange $26.66
Rate for Payer: Dignity Health Medi-Cal $26.66
Rate for Payer: Dignity Health Senior $26.66
Rate for Payer: EPIC Health Plan Commercial $20.07
Rate for Payer: Heritage Provider Network Commercial $19.41
Rate for Payer: Heritage Provider Network Senior $19.41
Rate for Payer: Kaiser Permanente of CA Commercial $14.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal $5.68
Rate for Payer: LLUH Dept of Risk Management WC $7.84
Rate for Payer: Molina Healthcare of CA Medi-Cal $21.95
Rate for Payer: Molina Healthcare of CA Medicare $21.95
Rate for Payer: Multiplan Commercial $23.52
Rate for Payer: TriValley Medical Group Commercial $12.54
Rate for Payer: TriValley Medical Group Senior $12.54
Rate for Payer: United Healthcare All Other HMO/non HMO $15.68
Rate for Payer: United Healthcare Navigate/Select/Select+ $15.68
Rate for Payer: Vantage Medical Group Commercial/Exchange $26.66
Rate for Payer: Vantage Medical Group Medi-Cal $26.66
Rate for Payer: Vantage Medical Group Senior $26.66
Service Code NDC 61314-044-75
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $5.68
Max. Negotiated Rate $23.52
Rate for Payer: Adventist Health Commercial $6.27
Rate for Payer: Cash Price $17.25
Rate for Payer: EPIC Health Plan Commercial $16.93
Rate for Payer: Heritage Provider Network Commercial $21.23
Rate for Payer: Heritage Provider Network Senior $21.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal $5.68
Rate for Payer: LLUH Dept of Risk Management WC $7.84
Rate for Payer: Multiplan Commercial $23.52
Service Code NDC 70954-212-10
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.15
Rate for Payer: Adventist Health Commercial $0.04
Rate for Payer: Aetna of CA Gatekeeper $0.10
Rate for Payer: Aetna of CA Non-Gatekeeper $0.12
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.15
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: Blue Shield of California Commercial $0.11
Rate for Payer: Blue Shield of California EPN $0.09
Rate for Payer: Cash Price $0.10
Rate for Payer: Cigna of CA HMO/PPO $0.12
Rate for Payer: Dignity Health Commercial/Exchange $0.15
Rate for Payer: Dignity Health Medi-Cal $0.15
Rate for Payer: Dignity Health Senior $0.15
Rate for Payer: EPIC Health Plan Commercial $0.12
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 Commercial $0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.13
Rate for Payer: Molina Healthcare of CA Medicare $0.13
Rate for Payer: Multiplan Commercial $0.14
Rate for Payer: TriValley Medical Group Commercial $0.07
Rate for Payer: TriValley Medical Group Senior $0.07
Rate for Payer: United Healthcare All Other HMO/non HMO $0.09
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.09
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.15
Rate for Payer: Vantage Medical Group Medi-Cal $0.15
Rate for Payer: Vantage Medical Group Senior $0.15
Service Code NDC 0591-5335-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.15
Rate for Payer: Adventist Health Commercial $0.04
Rate for Payer: Aetna of CA Gatekeeper $0.10
Rate for Payer: Aetna of CA Non-Gatekeeper $0.12
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.15
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: Blue Shield of California Commercial $0.11
Rate for Payer: Blue Shield of California EPN $0.09
Rate for Payer: Cash Price $0.10
Rate for Payer: Cigna of CA HMO/PPO $0.12
Rate for Payer: Dignity Health Commercial/Exchange $0.15
Rate for Payer: Dignity Health Medi-Cal $0.15
Rate for Payer: Dignity Health Senior $0.15
Rate for Payer: EPIC Health Plan Commercial $0.12
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 Commercial $0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.13
Rate for Payer: Molina Healthcare of CA Medicare $0.13
Rate for Payer: Multiplan Commercial $0.14
Rate for Payer: TriValley Medical Group Commercial $0.07
Rate for Payer: TriValley Medical Group Senior $0.07
Rate for Payer: United Healthcare All Other HMO/non HMO $0.09
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.09
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.15
Rate for Payer: Vantage Medical Group Medi-Cal $0.15
Rate for Payer: Vantage Medical Group Senior $0.15
Service Code NDC 70954-212-10
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.14
Rate for Payer: Adventist Health Commercial $0.04
Rate for Payer: Cash Price $0.10
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Heritage Provider Network Commercial $0.12
Rate for Payer: Heritage Provider Network Senior $0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Multiplan Commercial $0.14
Service Code NDC 0591-5335-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.14
Rate for Payer: Adventist Health Commercial $0.04
Rate for Payer: Cash Price $0.10
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Heritage Provider Network Commercial $0.12
Rate for Payer: Heritage Provider Network Senior $0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.05
Rate for Payer: Multiplan Commercial $0.14
Service Code NDC 70954-211-10
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.20
Rate for Payer: Adventist Health Commercial $0.05
Rate for Payer: Cash Price $0.15
Rate for Payer: EPIC Health Plan Commercial $0.15
Rate for Payer: Heritage Provider Network Commercial $0.18
Rate for Payer: Heritage Provider Network Senior $0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Multiplan Commercial $0.20
Service Code NDC 0591-5337-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.27
Rate for Payer: Adventist Health Commercial $0.07
Rate for Payer: Cash Price $0.20
Rate for Payer: EPIC Health Plan Commercial $0.19
Rate for Payer: Heritage Provider Network Commercial $0.24
Rate for Payer: Heritage Provider Network Senior $0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.27
Service Code NDC 0591-5337-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.31
Rate for Payer: Adventist Health Commercial $0.07
Rate for Payer: Aetna of CA Gatekeeper $0.19
Rate for Payer: Aetna of CA Non-Gatekeeper $0.25
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.31
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.20
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.27
Rate for Payer: Blue Shield of California Commercial $0.22
Rate for Payer: Blue Shield of California EPN $0.18
Rate for Payer: Cash Price $0.20
Rate for Payer: Cigna of CA HMO/PPO $0.23
Rate for Payer: Dignity Health Commercial/Exchange $0.31
Rate for Payer: Dignity Health Medi-Cal $0.31
Rate for Payer: Dignity Health Senior $0.31
Rate for Payer: EPIC Health Plan Commercial $0.23
Rate for Payer: Heritage Provider Network Commercial $0.22
Rate for Payer: Heritage Provider Network Senior $0.22
Rate for Payer: Kaiser Permanente of CA Commercial $0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.25
Rate for Payer: Molina Healthcare of CA Medicare $0.25
Rate for Payer: Multiplan Commercial $0.27
Rate for Payer: TriValley Medical Group Commercial $0.14
Rate for Payer: TriValley Medical Group Senior $0.14
Rate for Payer: United Healthcare All Other HMO/non HMO $0.18
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.18
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.31
Rate for Payer: Vantage Medical Group Medi-Cal $0.31
Rate for Payer: Vantage Medical Group Senior $0.31
Service Code NDC 70954-211-10
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.23
Rate for Payer: Adventist Health Commercial $0.05
Rate for Payer: Aetna of CA Gatekeeper $0.14
Rate for Payer: Aetna of CA Non-Gatekeeper $0.19
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.23
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.15
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.20
Rate for Payer: Blue Shield of California Commercial $0.16
Rate for Payer: Blue Shield of California EPN $0.13
Rate for Payer: Cash Price $0.15
Rate for Payer: Cigna of CA HMO/PPO $0.18
Rate for Payer: Dignity Health Commercial/Exchange $0.23
Rate for Payer: Dignity Health Medi-Cal $0.23
Rate for Payer: Dignity Health Senior $0.23
Rate for Payer: EPIC Health Plan Commercial $0.17
Rate for Payer: Heritage Provider Network Commercial $0.17
Rate for Payer: Heritage Provider Network Senior $0.17
Rate for Payer: Kaiser Permanente of CA Commercial $0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.19
Rate for Payer: Molina Healthcare of CA Medicare $0.19
Rate for Payer: Multiplan Commercial $0.20
Rate for Payer: TriValley Medical Group Commercial $0.11
Rate for Payer: TriValley Medical Group Senior $0.11
Rate for Payer: United Healthcare All Other HMO/non HMO $0.14
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.14
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.23
Rate for Payer: Vantage Medical Group Medi-Cal $0.23
Rate for Payer: Vantage Medical Group Senior $0.23
Service Code HCPCS J3250
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $6.58
Max. Negotiated Rate $157.02
Rate for Payer: Adventist Health Commercial $7.28
Rate for Payer: Aetna of CA Gatekeeper $19.45
Rate for Payer: Aetna of CA Non-Gatekeeper $24.99
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $30.92
Rate for Payer: Alpha Care Medical Group Medi-Cal $20.01
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $27.29
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $157.02
Rate for Payer: Blue Shield of California Commercial $53.77
Rate for Payer: Blue Shield of California EPN $53.77
Rate for Payer: Cash Price $20.01
Rate for Payer: Cash Price $20.01
Rate for Payer: Cigna of CA HMO/PPO $16.73
Rate for Payer: Dignity Health Commercial/Exchange $30.92
Rate for Payer: Dignity Health Medi-Cal $30.92
Rate for Payer: Dignity Health Senior $30.92
Rate for Payer: EPIC Health Plan Commercial $23.28
Rate for Payer: Heritage Provider Network Commercial $16.84
Rate for Payer: Heritage Provider Network Senior $16.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $50.04
Rate for Payer: Kaiser Permanente of CA Commercial $17.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal $6.58
Rate for Payer: LLUH Dept of Risk Management WC $9.10
Rate for Payer: Molina Healthcare of CA Medi-Cal $25.47
Rate for Payer: Molina Healthcare of CA Medicare $25.47
Rate for Payer: Multiplan Commercial $27.29
Rate for Payer: TriValley Medical Group Commercial $14.55
Rate for Payer: TriValley Medical Group Senior $14.55
Rate for Payer: United Healthcare All Other HMO/non HMO $13.14
Rate for Payer: United Healthcare Navigate/Select/Select+ $12.05
Rate for Payer: Vantage Medical Group Commercial/Exchange $30.92
Rate for Payer: Vantage Medical Group Medi-Cal $30.92
Rate for Payer: Vantage Medical Group Senior $30.92
Service Code HCPCS J3250
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $6.58
Max. Negotiated Rate $27.29
Rate for Payer: Adventist Health Commercial $7.28
Rate for Payer: Cash Price $20.01
Rate for Payer: Cigna of CA HMO/PPO $16.73
Rate for Payer: EPIC Health Plan Commercial $19.65
Rate for Payer: Heritage Provider Network Commercial $16.84
Rate for Payer: Heritage Provider Network Senior $16.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal $6.58
Rate for Payer: LLUH Dept of Risk Management WC $9.10
Rate for Payer: Multiplan Commercial $27.29
Rate for Payer: United Healthcare All Other HMO/non HMO $13.14
Rate for Payer: United Healthcare Navigate/Select/Select+ $12.05
Service Code NDC 0409-1593-14
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.80
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Aetna of CA Gatekeeper $0.50
Rate for Payer: Aetna of CA Non-Gatekeeper $0.65
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.80
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.52
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.71
Rate for Payer: Blue Shield of California Commercial $0.57
Rate for Payer: Blue Shield of California EPN $0.46
Rate for Payer: Cash Price $0.52
Rate for Payer: Cigna of CA HMO/PPO $0.61
Rate for Payer: Dignity Health Commercial/Exchange $0.80
Rate for Payer: Dignity Health Medi-Cal $0.80
Rate for Payer: Dignity Health Senior $0.80
Rate for Payer: EPIC Health Plan Commercial $0.60
Rate for Payer: Heritage Provider Network Commercial $0.58
Rate for Payer: Heritage Provider Network Senior $0.58
Rate for Payer: Kaiser Permanente of CA Commercial $0.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.66
Rate for Payer: Molina Healthcare of CA Medicare $0.66
Rate for Payer: Multiplan Commercial $0.71
Rate for Payer: TriValley Medical Group Commercial $0.38
Rate for Payer: TriValley Medical Group Senior $0.38
Rate for Payer: United Healthcare All Other HMO/non HMO $0.47
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.47
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.80
Rate for Payer: Vantage Medical Group Medi-Cal $0.80
Rate for Payer: Vantage Medical Group Senior $0.80
Service Code NDC 0409-1593-04
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.80
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Aetna of CA Gatekeeper $0.50
Rate for Payer: Aetna of CA Non-Gatekeeper $0.65
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.80
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.52
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.71
Rate for Payer: Blue Shield of California Commercial $0.57
Rate for Payer: Blue Shield of California EPN $0.46
Rate for Payer: Cash Price $0.52
Rate for Payer: Cigna of CA HMO/PPO $0.61
Rate for Payer: Dignity Health Commercial/Exchange $0.80
Rate for Payer: Dignity Health Medi-Cal $0.80
Rate for Payer: Dignity Health Senior $0.80
Rate for Payer: EPIC Health Plan Commercial $0.60
Rate for Payer: Heritage Provider Network Commercial $0.58
Rate for Payer: Heritage Provider Network Senior $0.58
Rate for Payer: Kaiser Permanente of CA Commercial $0.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.66
Rate for Payer: Molina Healthcare of CA Medicare $0.66
Rate for Payer: Multiplan Commercial $0.71
Rate for Payer: TriValley Medical Group Commercial $0.38
Rate for Payer: TriValley Medical Group Senior $0.38
Rate for Payer: United Healthcare All Other HMO/non HMO $0.47
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.47
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.80
Rate for Payer: Vantage Medical Group Medi-Cal $0.80
Rate for Payer: Vantage Medical Group Senior $0.80
Service Code NDC 0409-1593-14
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.71
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Cash Price $0.52
Rate for Payer: EPIC Health Plan Commercial $0.51
Rate for Payer: Heritage Provider Network Commercial $0.64
Rate for Payer: Heritage Provider Network Senior $0.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.71
Service Code NDC 0409-1593-04
Hospital Charge Code 901700004
Hospital Revenue Code 250
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.71
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Cash Price $0.52
Rate for Payer: EPIC Health Plan Commercial $0.51
Rate for Payer: Heritage Provider Network Commercial $0.64
Rate for Payer: Heritage Provider Network Senior $0.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.17
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.71
Service Code NDC 61314-354-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.31
Max. Negotiated Rate $1.28
Rate for Payer: Adventist Health Commercial $0.34
Rate for Payer: Cash Price $0.94
Rate for Payer: EPIC Health Plan Commercial $0.92
Rate for Payer: Heritage Provider Network Commercial $1.16
Rate for Payer: Heritage Provider Network Senior $1.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.31
Rate for Payer: LLUH Dept of Risk Management WC $0.43
Rate for Payer: Multiplan Commercial $1.28
Service Code NDC 61314-354-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.31
Max. Negotiated Rate $1.45
Rate for Payer: Adventist Health Commercial $0.34
Rate for Payer: Aetna of CA Gatekeeper $0.91
Rate for Payer: Aetna of CA Non-Gatekeeper $1.17
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $1.45
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.94
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $1.28
Rate for Payer: Blue Shield of California Commercial $1.04
Rate for Payer: Blue Shield of California EPN $0.83
Rate for Payer: Cash Price $0.94
Rate for Payer: Cigna of CA HMO/PPO $1.11
Rate for Payer: Dignity Health Commercial/Exchange $1.45
Rate for Payer: Dignity Health Medi-Cal $1.45
Rate for Payer: Dignity Health Senior $1.45
Rate for Payer: EPIC Health Plan Commercial $1.09
Rate for Payer: Heritage Provider Network Commercial $1.06
Rate for Payer: Heritage Provider Network Senior $1.06
Rate for Payer: Kaiser Permanente of CA Commercial $0.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.31
Rate for Payer: LLUH Dept of Risk Management WC $0.43
Rate for Payer: Molina Healthcare of CA Medi-Cal $1.20
Rate for Payer: Molina Healthcare of CA Medicare $1.20
Rate for Payer: Multiplan Commercial $1.28
Rate for Payer: TriValley Medical Group Commercial $0.68
Rate for Payer: TriValley Medical Group Senior $0.68
Rate for Payer: United Healthcare All Other HMO/non HMO $0.86
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.86
Rate for Payer: Vantage Medical Group Commercial/Exchange $1.45
Rate for Payer: Vantage Medical Group Medi-Cal $1.45
Rate for Payer: Vantage Medical Group Senior $1.45
Service Code NDC 61314-355-02
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.44
Max. Negotiated Rate $1.84
Rate for Payer: Adventist Health Commercial $0.49
Rate for Payer: Cash Price $1.35
Rate for Payer: EPIC Health Plan Commercial $1.32
Rate for Payer: Heritage Provider Network Commercial $1.66
Rate for Payer: Heritage Provider Network Senior $1.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.44
Rate for Payer: LLUH Dept of Risk Management WC $0.61
Rate for Payer: Multiplan Commercial $1.84
Service Code NDC 70069-121-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.51
Rate for Payer: Adventist Health Commercial $0.14
Rate for Payer: Cash Price $0.37
Rate for Payer: EPIC Health Plan Commercial $0.37
Rate for Payer: Heritage Provider Network Commercial $0.46
Rate for Payer: Heritage Provider Network Senior $0.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.12
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Multiplan Commercial $0.51
Service Code NDC 70069-121-01
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.58
Rate for Payer: Adventist Health Commercial $0.14
Rate for Payer: Aetna of CA Gatekeeper $0.36
Rate for Payer: Aetna of CA Non-Gatekeeper $0.47
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.58
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.37
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.51
Rate for Payer: Blue Shield of California Commercial $0.41
Rate for Payer: Blue Shield of California EPN $0.33
Rate for Payer: Cash Price $0.37
Rate for Payer: Cigna of CA HMO/PPO $0.44
Rate for Payer: Dignity Health Commercial/Exchange $0.58
Rate for Payer: Dignity Health Medi-Cal $0.58
Rate for Payer: Dignity Health Senior $0.58
Rate for Payer: EPIC Health Plan Commercial $0.44
Rate for Payer: Heritage Provider Network Commercial $0.42
Rate for Payer: Heritage Provider Network Senior $0.42
Rate for Payer: Kaiser Permanente of CA Commercial $0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.12
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.48
Rate for Payer: Molina Healthcare of CA Medicare $0.48
Rate for Payer: Multiplan Commercial $0.51
Rate for Payer: TriValley Medical Group Commercial $0.27
Rate for Payer: TriValley Medical Group Senior $0.27
Rate for Payer: United Healthcare All Other HMO/non HMO $0.34
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.34
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.58
Rate for Payer: Vantage Medical Group Medi-Cal $0.58
Rate for Payer: Vantage Medical Group Senior $0.58
Service Code NDC 61314-355-02
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.44
Max. Negotiated Rate $2.08
Rate for Payer: Adventist Health Commercial $0.49
Rate for Payer: Aetna of CA Gatekeeper $1.31
Rate for Payer: Aetna of CA Non-Gatekeeper $1.68
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $2.08
Rate for Payer: Alpha Care Medical Group Medi-Cal $1.35
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $1.84
Rate for Payer: Blue Shield of California Commercial $1.49
Rate for Payer: Blue Shield of California EPN $1.20
Rate for Payer: Cash Price $1.35
Rate for Payer: Cigna of CA HMO/PPO $1.59
Rate for Payer: Dignity Health Commercial/Exchange $2.08
Rate for Payer: Dignity Health Medi-Cal $2.08
Rate for Payer: Dignity Health Senior $2.08
Rate for Payer: EPIC Health Plan Commercial $1.57
Rate for Payer: Heritage Provider Network Commercial $1.52
Rate for Payer: Heritage Provider Network Senior $1.52
Rate for Payer: Kaiser Permanente of CA Commercial $1.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.44
Rate for Payer: LLUH Dept of Risk Management WC $0.61
Rate for Payer: Molina Healthcare of CA Medi-Cal $1.72
Rate for Payer: Molina Healthcare of CA Medicare $1.72
Rate for Payer: Multiplan Commercial $1.84
Rate for Payer: TriValley Medical Group Commercial $0.98
Rate for Payer: TriValley Medical Group Senior $0.98
Rate for Payer: United Healthcare All Other HMO/non HMO $1.23
Rate for Payer: United Healthcare Navigate/Select/Select+ $1.23
Rate for Payer: Vantage Medical Group Commercial/Exchange $2.08
Rate for Payer: Vantage Medical Group Medi-Cal $2.08
Rate for Payer: Vantage Medical Group Senior $2.08
Service Code HCPCS J3490
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $3.04
Max. Negotiated Rate $12.60
Rate for Payer: Adventist Health Commercial $3.36
Rate for Payer: Cash Price $9.24
Rate for Payer: Cigna of CA HMO/PPO $7.73
Rate for Payer: EPIC Health Plan Commercial $9.07
Rate for Payer: Heritage Provider Network Commercial $7.78
Rate for Payer: Heritage Provider Network Senior $7.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal $3.04
Rate for Payer: LLUH Dept of Risk Management WC $4.20
Rate for Payer: Multiplan Commercial $12.60
Rate for Payer: United Healthcare All Other HMO/non HMO $6.07
Rate for Payer: United Healthcare Navigate/Select/Select+ $5.56
Service Code HCPCS J3490
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $3.04
Max. Negotiated Rate $14.28
Rate for Payer: Adventist Health Commercial $3.36
Rate for Payer: Aetna of CA Gatekeeper $8.98
Rate for Payer: Aetna of CA Non-Gatekeeper $11.54
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $14.28
Rate for Payer: Alpha Care Medical Group Medi-Cal $9.24
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $12.60
Rate for Payer: Blue Shield of California Commercial $10.25
Rate for Payer: Blue Shield of California EPN $8.20
Rate for Payer: Cash Price $9.24
Rate for Payer: Cigna of CA HMO/PPO $7.73
Rate for Payer: Dignity Health Commercial/Exchange $14.28
Rate for Payer: Dignity Health Medi-Cal $14.28
Rate for Payer: Dignity Health Senior $14.28
Rate for Payer: EPIC Health Plan Commercial $10.75
Rate for Payer: Heritage Provider Network Commercial $7.78
Rate for Payer: Heritage Provider Network Senior $7.78
Rate for Payer: Kaiser Permanente of CA Commercial $8.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal $3.04
Rate for Payer: LLUH Dept of Risk Management WC $4.20
Rate for Payer: Molina Healthcare of CA Medi-Cal $11.76
Rate for Payer: Molina Healthcare of CA Medicare $11.76
Rate for Payer: Multiplan Commercial $12.60
Rate for Payer: TriValley Medical Group Commercial $6.72
Rate for Payer: TriValley Medical Group Senior $6.72
Rate for Payer: United Healthcare All Other HMO/non HMO $6.07
Rate for Payer: United Healthcare Navigate/Select/Select+ $5.56
Rate for Payer: Vantage Medical Group Commercial/Exchange $14.28
Rate for Payer: Vantage Medical Group Medi-Cal $14.28
Rate for Payer: Vantage Medical Group Senior $14.28
Service Code HCPCS Q9968
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $36.01
Max. Negotiated Rate $149.22
Rate for Payer: Adventist Health Commercial $39.79
Rate for Payer: Cash Price $109.43
Rate for Payer: Cigna of CA HMO/PPO $91.52
Rate for Payer: EPIC Health Plan Commercial $107.44
Rate for Payer: Heritage Provider Network Commercial $92.12
Rate for Payer: Heritage Provider Network Senior $92.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal $36.01
Rate for Payer: LLUH Dept of Risk Management WC $49.74
Rate for Payer: Multiplan Commercial $149.22
Rate for Payer: United Healthcare All Other HMO/non HMO $71.88
Rate for Payer: United Healthcare Navigate/Select/Select+ $65.88