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Charge Type Price  
Service Code ICD 0SG10KJ
Min. Negotiated Rate $13,963.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $13,963.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code ICD 0SG0470
Min. Negotiated Rate $13,963.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $13,963.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code ICD 0RG14J0
Min. Negotiated Rate $13,963.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $13,963.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code ICD 0RG13A0
Min. Negotiated Rate $13,963.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $13,963.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code ICD 0SG30AJ
Min. Negotiated Rate $13,963.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $13,963.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code ICD 0SG34K0
Min. Negotiated Rate $13,963.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $13,963.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code ICD 0SG50KZ
Min. Negotiated Rate $13,963.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $13,963.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code ICD 00UT3JZ
Min. Negotiated Rate $17,082.00
Max. Negotiated Rate $19,930.00
Rate for Payer: Blue Shield of California Commercial $19,930.00
Rate for Payer: Blue Shield of California EPN $17,082.00
Service Code NDC 16729-227-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.48
Rate for Payer: Adventist Health Commercial $0.13
Rate for Payer: Aetna of CA Non-Gatekeeper $0.44
Rate for Payer: Cash Price $0.29
Rate for Payer: EPIC Health Plan Commercial $0.35
Rate for Payer: Heritage Provider Network Commercial $0.43
Rate for Payer: Heritage Provider Network Senior $0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.12
Rate for Payer: LLUH Dept of Risk Management WC $0.16
Rate for Payer: Multiplan Commercial $0.48
Service Code NDC 59746-218-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.40
Rate for Payer: Adventist Health Commercial $0.09
Rate for Payer: Aetna of CA Gatekeeper $0.25
Rate for Payer: Aetna of CA Non-Gatekeeper $0.32
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.40
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.26
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.35
Rate for Payer: Blue Shield of California Commercial $0.29
Rate for Payer: Blue Shield of California EPN $0.28
Rate for Payer: Cash Price $0.21
Rate for Payer: Cigna of CA HMO/PPO $0.31
Rate for Payer: Dignity Health Commercial/Exchange $0.40
Rate for Payer: Dignity Health Medi-Cal $0.40
Rate for Payer: Dignity Health Senior $0.40
Rate for Payer: EPIC Health Plan Commercial $0.30
Rate for Payer: Heritage Provider Network Commercial $0.29
Rate for Payer: Heritage Provider Network Senior $0.29
Rate for Payer: Kaiser Permanente of CA Commercial $0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.12
Rate for Payer: Multiplan Commercial $0.35
Rate for Payer: Vantage Medical Group Medi-Cal $0.40
Rate for Payer: Vantage Medical Group Senior $0.40
Service Code NDC 59746-218-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.35
Rate for Payer: Adventist Health Commercial $0.09
Rate for Payer: Aetna of CA Non-Gatekeeper $0.32
Rate for Payer: Cash Price $0.21
Rate for Payer: EPIC Health Plan Commercial $0.25
Rate for Payer: Heritage Provider Network Commercial $0.32
Rate for Payer: Heritage Provider Network Senior $0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.12
Rate for Payer: Multiplan Commercial $0.35
Service Code NDC 53746-515-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.54
Rate for Payer: Adventist Health Commercial $0.13
Rate for Payer: Aetna of CA Gatekeeper $0.34
Rate for Payer: Aetna of CA Non-Gatekeeper $0.44
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.54
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.35
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.48
Rate for Payer: Blue Shield of California Commercial $0.40
Rate for Payer: Blue Shield of California EPN $0.38
Rate for Payer: Cash Price $0.29
Rate for Payer: Cigna of CA HMO/PPO $0.42
Rate for Payer: Dignity Health Commercial/Exchange $0.54
Rate for Payer: Dignity Health Medi-Cal $0.54
Rate for Payer: Dignity Health Senior $0.54
Rate for Payer: EPIC Health Plan Commercial $0.41
Rate for Payer: Heritage Provider Network Commercial $0.40
Rate for Payer: Heritage Provider Network Senior $0.40
Rate for Payer: Kaiser Permanente of CA Commercial $0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.12
Rate for Payer: LLUH Dept of Risk Management WC $0.16
Rate for Payer: Multiplan Commercial $0.48
Rate for Payer: Vantage Medical Group Medi-Cal $0.54
Rate for Payer: Vantage Medical Group Senior $0.54
Service Code NDC 53489-329-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.48
Rate for Payer: Adventist Health Commercial $0.11
Rate for Payer: Aetna of CA Gatekeeper $0.30
Rate for Payer: Aetna of CA Non-Gatekeeper $0.39
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.48
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.31
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.43
Rate for Payer: Blue Shield of California Commercial $0.35
Rate for Payer: Blue Shield of California EPN $0.33
Rate for Payer: Cash Price $0.26
Rate for Payer: Cigna of CA HMO/PPO $0.37
Rate for Payer: Dignity Health Commercial/Exchange $0.48
Rate for Payer: Dignity Health Medi-Cal $0.48
Rate for Payer: Dignity Health Senior $0.48
Rate for Payer: EPIC Health Plan Commercial $0.36
Rate for Payer: Heritage Provider Network Commercial $0.35
Rate for Payer: Heritage Provider Network Senior $0.35
Rate for Payer: Kaiser Permanente of CA Commercial $0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.43
Rate for Payer: Vantage Medical Group Medi-Cal $0.48
Rate for Payer: Vantage Medical Group Senior $0.48
Service Code NDC 53746-515-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.48
Rate for Payer: Adventist Health Commercial $0.13
Rate for Payer: Aetna of CA Non-Gatekeeper $0.44
Rate for Payer: Cash Price $0.29
Rate for Payer: EPIC Health Plan Commercial $0.35
Rate for Payer: Heritage Provider Network Commercial $0.43
Rate for Payer: Heritage Provider Network Senior $0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.12
Rate for Payer: LLUH Dept of Risk Management WC $0.16
Rate for Payer: Multiplan Commercial $0.48
Service Code NDC 16729-227-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.54
Rate for Payer: Adventist Health Commercial $0.13
Rate for Payer: Aetna of CA Gatekeeper $0.34
Rate for Payer: Aetna of CA Non-Gatekeeper $0.44
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.54
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.35
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.48
Rate for Payer: Blue Shield of California Commercial $0.40
Rate for Payer: Blue Shield of California EPN $0.38
Rate for Payer: Cash Price $0.29
Rate for Payer: Cigna of CA HMO/PPO $0.42
Rate for Payer: Dignity Health Commercial/Exchange $0.54
Rate for Payer: Dignity Health Medi-Cal $0.54
Rate for Payer: Dignity Health Senior $0.54
Rate for Payer: EPIC Health Plan Commercial $0.41
Rate for Payer: Heritage Provider Network Commercial $0.40
Rate for Payer: Heritage Provider Network Senior $0.40
Rate for Payer: Kaiser Permanente of CA Commercial $0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.12
Rate for Payer: LLUH Dept of Risk Management WC $0.16
Rate for Payer: Multiplan Commercial $0.48
Rate for Payer: Vantage Medical Group Medi-Cal $0.54
Rate for Payer: Vantage Medical Group Senior $0.54
Service Code NDC 53489-329-01
Hospital Charge Code 1710137
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.43
Rate for Payer: Adventist Health Commercial $0.11
Rate for Payer: Aetna of CA Non-Gatekeeper $0.39
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 Permanente of CA Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.43
Service Code NDC 9994-0815-82
Hospital Charge Code ERX4081582
Hospital Revenue Code 259
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.06
Rate for Payer: Adventist Health Commercial $0.01
Rate for Payer: Aetna of CA Gatekeeper $0.04
Rate for Payer: Aetna of CA Non-Gatekeeper $0.05
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.06
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.04
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.05
Rate for Payer: Blue Shield of California Commercial $0.04
Rate for Payer: Blue Shield of California EPN $0.04
Rate for Payer: Cash Price $0.03
Rate for Payer: Cigna of CA HMO/PPO $0.05
Rate for Payer: Dignity Health Commercial/Exchange $0.06
Rate for Payer: Dignity Health Medi-Cal $0.06
Rate for Payer: Dignity Health Senior $0.06
Rate for Payer: EPIC Health Plan Commercial $0.04
Rate for Payer: Heritage Provider Network Commercial $0.04
Rate for Payer: Heritage Provider Network Senior $0.04
Rate for Payer: Kaiser Permanente of CA Commercial $0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.05
Rate for Payer: Vantage Medical Group Medi-Cal $0.06
Rate for Payer: Vantage Medical Group Senior $0.06
Service Code NDC 9994-0815-82
Hospital Charge Code ERX4081582
Hospital Revenue Code 259
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.05
Rate for Payer: Adventist Health Commercial $0.01
Rate for Payer: Aetna of CA Non-Gatekeeper $0.05
Rate for Payer: Cash Price $0.03
Rate for Payer: EPIC Health Plan Commercial $0.04
Rate for Payer: Heritage Provider Network Commercial $0.05
Rate for Payer: Heritage Provider Network Senior $0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.05
Service Code NDC 53489-144-01
Hospital Charge Code 1711768
Hospital Revenue Code 259
Min. Negotiated Rate $0.26
Max. Negotiated Rate $1.24
Rate for Payer: Adventist Health Commercial $0.29
Rate for Payer: Aetna of CA Gatekeeper $0.78
Rate for Payer: Aetna of CA Non-Gatekeeper $1.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $1.24
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.80
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $1.10
Rate for Payer: Blue Shield of California Commercial $0.91
Rate for Payer: Blue Shield of California EPN $0.86
Rate for Payer: Cash Price $0.66
Rate for Payer: Cigna of CA HMO/PPO $0.95
Rate for Payer: Dignity Health Commercial/Exchange $1.24
Rate for Payer: Dignity Health Medi-Cal $1.24
Rate for Payer: Dignity Health Senior $1.24
Rate for Payer: EPIC Health Plan Commercial $0.93
Rate for Payer: Heritage Provider Network Commercial $0.90
Rate for Payer: Heritage Provider Network Senior $0.90
Rate for Payer: Kaiser Permanente of CA Commercial $0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.37
Rate for Payer: Multiplan Commercial $1.10
Rate for Payer: Vantage Medical Group Medi-Cal $1.24
Rate for Payer: Vantage Medical Group Senior $1.24
Service Code NDC 53489-144-01
Hospital Charge Code 1711768
Hospital Revenue Code 259
Min. Negotiated Rate $0.26
Max. Negotiated Rate $1.10
Rate for Payer: Adventist Health Commercial $0.29
Rate for Payer: Aetna of CA Non-Gatekeeper $1.00
Rate for Payer: Cash Price $0.66
Rate for Payer: EPIC Health Plan Commercial $0.79
Rate for Payer: Heritage Provider Network Commercial $0.99
Rate for Payer: Heritage Provider Network Senior $0.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.37
Rate for Payer: Multiplan Commercial $1.10
Service Code NDC 59651-426-01
Hospital Charge Code 1710088
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.11
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Aetna of CA Non-Gatekeeper $0.10
Rate for Payer: Cash Price $0.07
Rate for Payer: EPIC Health Plan Commercial $0.08
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 Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.04
Rate for Payer: Multiplan Commercial $0.11
Service Code NDC 0378-2146-01
Hospital Charge Code 1710088
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: Aetna of CA Non-Gatekeeper $0.13
Rate for Payer: Cash Price $0.09
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Heritage Provider Network Commercial $0.13
Rate for Payer: Heritage Provider Network Senior $0.13
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 0904-6927-61
Hospital Charge Code 1710088
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 Gatekeeper $0.10
Rate for Payer: Aetna of CA Non-Gatekeeper $0.13
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.16
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.10
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.14
Rate for Payer: Blue Shield of California Commercial $0.12
Rate for Payer: Blue Shield of California EPN $0.11
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 Senior $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 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: Multiplan Commercial $0.14
Rate for Payer: Vantage Medical Group Medi-Cal $0.16
Rate for Payer: Vantage Medical Group Senior $0.16
Service Code NDC 60687-465-01
Hospital Charge Code 1710088
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 $0.12
Rate for Payer: Aetna of CA Non-Gatekeeper $0.16
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.20
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.13
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.17
Rate for Payer: Blue Shield of California Commercial $0.14
Rate for Payer: Blue Shield of California EPN $0.14
Rate for Payer: Cash Price $0.10
Rate for Payer: Cigna of CA HMO/PPO $0.15
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 $0.14
Rate for Payer: Heritage Provider Network Senior $0.14
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: Multiplan Commercial $0.17
Rate for Payer: Vantage Medical Group Medi-Cal $0.20
Rate for Payer: Vantage Medical Group Senior $0.20
Service Code NDC 53489-143-01
Hospital Charge Code 1710088
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 Permanente of CA Medi-Cal $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.09