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Service Code NDC 0904-6401-61
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.40
Rate for Payer: Adventist Health Commercial $0.11
Rate for Payer: Aetna of CA Non-Gatekeeper $0.36
Rate for Payer: Cash Price $0.24
Rate for Payer: EPIC Health Plan Commercial $0.29
Rate for Payer: Heritage Provider Network Commercial $0.36
Rate for Payer: Heritage Provider Network Senior $0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.40
Service Code NDC 68382-132-01
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.28
Rate for Payer: Adventist Health Commercial $0.07
Rate for Payer: Aetna of CA Gatekeeper $0.18
Rate for Payer: Aetna of CA Non-Gatekeeper $0.23
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.28
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.18
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.25
Rate for Payer: Blue Shield of California Commercial $0.20
Rate for Payer: Blue Shield of California EPN $0.19
Rate for Payer: Cash Price $0.15
Rate for Payer: Cigna of CA HMO/PPO $0.21
Rate for Payer: Dignity Health Commercial/Exchange $0.28
Rate for Payer: Dignity Health Medi-Cal $0.28
Rate for Payer: Dignity Health Senior $0.28
Rate for Payer: EPIC Health Plan Commercial $0.21
Rate for Payer: Heritage Provider Network Commercial $0.20
Rate for Payer: Heritage Provider Network Senior $0.20
Rate for Payer: Kaiser Permanente of CA Commercial $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.06
Rate for Payer: LLUH Dept of Risk Management WC $0.08
Rate for Payer: Multiplan Commercial $0.25
Rate for Payer: Vantage Medical Group Medi-Cal $0.28
Rate for Payer: Vantage Medical Group Senior $0.28
Service Code NDC 65862-598-01
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.07
Rate for Payer: Adventist Health Commercial $0.02
Rate for Payer: Aetna of CA Non-Gatekeeper $0.06
Rate for Payer: Cash Price $0.04
Rate for Payer: EPIC Health Plan Commercial $0.05
Rate for Payer: Heritage Provider Network Commercial $0.06
Rate for Payer: Heritage Provider Network Senior $0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.07
Service Code NDC 65862-598-01
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.08
Rate for Payer: Adventist Health Commercial $0.02
Rate for Payer: Aetna of CA Gatekeeper $0.05
Rate for Payer: Aetna of CA Non-Gatekeeper $0.06
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.08
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.05
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.07
Rate for Payer: Blue Shield of California Commercial $0.06
Rate for Payer: Blue Shield of California EPN $0.05
Rate for Payer: Cash Price $0.04
Rate for Payer: Cigna of CA HMO/PPO $0.06
Rate for Payer: Dignity Health Commercial/Exchange $0.08
Rate for Payer: Dignity Health Medi-Cal $0.08
Rate for Payer: Dignity Health Senior $0.08
Rate for Payer: EPIC Health Plan Commercial $0.06
Rate for Payer: Heritage Provider Network Commercial $0.06
Rate for Payer: Heritage Provider Network Senior $0.06
Rate for Payer: Kaiser Permanente of CA Commercial $0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.07
Rate for Payer: Vantage Medical Group Medi-Cal $0.08
Rate for Payer: Vantage Medical Group Senior $0.08
Service Code NDC 68084-299-01
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.53
Rate for Payer: Adventist Health Commercial $0.14
Rate for Payer: Aetna of CA Non-Gatekeeper $0.49
Rate for Payer: Cash Price $0.32
Rate for Payer: EPIC Health Plan Commercial $0.38
Rate for Payer: Heritage Provider Network Commercial $0.48
Rate for Payer: Heritage Provider Network Senior $0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Commercial $0.53
Service Code NDC 68084-299-01
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.60
Rate for Payer: Adventist Health Commercial $0.14
Rate for Payer: Aetna of CA Gatekeeper $0.38
Rate for Payer: Aetna of CA Non-Gatekeeper $0.49
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.60
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.39
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.53
Rate for Payer: Blue Shield of California Commercial $0.44
Rate for Payer: Blue Shield of California EPN $0.42
Rate for Payer: Cash Price $0.32
Rate for Payer: Cigna of CA HMO/PPO $0.46
Rate for Payer: Dignity Health Commercial/Exchange $0.60
Rate for Payer: Dignity Health Medi-Cal $0.60
Rate for Payer: Dignity Health Senior $0.60
Rate for Payer: EPIC Health Plan Commercial $0.45
Rate for Payer: Heritage Provider Network Commercial $0.44
Rate for Payer: Heritage Provider Network Senior $0.44
Rate for Payer: Kaiser Permanente of CA Commercial $0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Commercial $0.53
Rate for Payer: Vantage Medical Group Medi-Cal $0.60
Rate for Payer: Vantage Medical Group Senior $0.60
Service Code NDC 0904-6401-89
Hospital Charge Code 1711755
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 62756-160-88
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.25
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Aetna of CA Gatekeeper $0.16
Rate for Payer: Aetna of CA Non-Gatekeeper $0.20
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.25
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.16
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.22
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.17
Rate for Payer: Cash Price $0.13
Rate for Payer: Cigna of CA HMO/PPO $0.19
Rate for Payer: Dignity Health Commercial/Exchange $0.25
Rate for Payer: Dignity Health Medi-Cal $0.25
Rate for Payer: Dignity Health Senior $0.25
Rate for Payer: EPIC Health Plan Commercial $0.19
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 Commercial $0.14
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 $0.22
Rate for Payer: Vantage Medical Group Medi-Cal $0.25
Rate for Payer: Vantage Medical Group Senior $0.25
Service Code NDC 68084-299-11
Hospital Charge Code 1711755
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.60
Rate for Payer: Adventist Health Commercial $0.14
Rate for Payer: Aetna of CA Gatekeeper $0.38
Rate for Payer: Aetna of CA Non-Gatekeeper $0.49
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.60
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.39
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.53
Rate for Payer: Blue Shield of California Commercial $0.44
Rate for Payer: Blue Shield of California EPN $0.42
Rate for Payer: Cash Price $0.32
Rate for Payer: Cigna of CA HMO/PPO $0.46
Rate for Payer: Dignity Health Commercial/Exchange $0.60
Rate for Payer: Dignity Health Medi-Cal $0.60
Rate for Payer: Dignity Health Senior $0.60
Rate for Payer: EPIC Health Plan Commercial $0.45
Rate for Payer: Heritage Provider Network Commercial $0.44
Rate for Payer: Heritage Provider Network Senior $0.44
Rate for Payer: Kaiser Permanente of CA Commercial $0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.13
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Commercial $0.53
Rate for Payer: Vantage Medical Group Medi-Cal $0.60
Rate for Payer: Vantage Medical Group Senior $0.60
Service Code NDC 24510-050-10
Hospital Charge Code 1730175
Hospital Revenue Code 259
Min. Negotiated Rate $2.09
Max. Negotiated Rate $8.67
Rate for Payer: Adventist Health Commercial $2.31
Rate for Payer: Aetna of CA Non-Gatekeeper $7.94
Rate for Payer: Cash Price $5.20
Rate for Payer: EPIC Health Plan Commercial $6.24
Rate for Payer: Heritage Provider Network Commercial $7.83
Rate for Payer: Heritage Provider Network Senior $7.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.09
Rate for Payer: LLUH Dept of Risk Management WC $2.89
Rate for Payer: Multiplan Commercial $8.67
Service Code NDC 24510-050-10
Hospital Charge Code 1730175
Hospital Revenue Code 259
Min. Negotiated Rate $2.09
Max. Negotiated Rate $9.83
Rate for Payer: Adventist Health Commercial $2.31
Rate for Payer: Aetna of CA Gatekeeper $6.18
Rate for Payer: Aetna of CA Non-Gatekeeper $7.94
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $9.83
Rate for Payer: AlphaCare Medical Group Medi-Cal $6.36
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $8.67
Rate for Payer: Blue Shield of California Commercial $7.18
Rate for Payer: Blue Shield of California EPN $6.79
Rate for Payer: Cash Price $5.20
Rate for Payer: Cigna of CA HMO/PPO $7.51
Rate for Payer: Dignity Health Commercial/Exchange $9.83
Rate for Payer: Dignity Health Medi-Cal $9.83
Rate for Payer: Dignity Health Senior $9.83
Rate for Payer: EPIC Health Plan Commercial $7.40
Rate for Payer: Heritage Provider Network Commercial $7.16
Rate for Payer: Heritage Provider Network Senior $7.16
Rate for Payer: Kaiser Permanente of CA Commercial $5.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.09
Rate for Payer: LLUH Dept of Risk Management WC $2.89
Rate for Payer: Multiplan Commercial $8.67
Rate for Payer: Vantage Medical Group Medi-Cal $9.83
Rate for Payer: Vantage Medical Group Senior $9.83
Service Code CPT 11920
Min. Negotiated Rate $784.71
Max. Negotiated Rate $9,616.00
Rate for Payer: Aetna of CA Gatekeeper $1,335.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $1,177.06
Rate for Payer: AlphaCare Medical Group Medi-Cal $863.18
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $784.71
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,237.00
Rate for Payer: Dignity Health Commercial/Exchange $1,177.06
Rate for Payer: Dignity Health Medi-Cal $863.18
Rate for Payer: Dignity Health Senior $784.71
Rate for Payer: EPIC Health Plan Commercial $9,616.00
Rate for Payer: EPIC Health Plan Medicare $784.71
Rate for Payer: Humana Medicare $784.71
Rate for Payer: IEHP Medicare Advantage $784.71
Rate for Payer: Kaiser Permanente of CA Commercial $1,490.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $925.96
Rate for Payer: Molina Healthcare of CA Medi-Cal $988.73
Rate for Payer: Molina Healthcare of CA Medicare $988.73
Rate for Payer: TriValley Medical Group Commercial $863.18
Rate for Payer: TriValley Medical Group Senior $784.71
Rate for Payer: Vantage Medical Group Commercial/Exchange $1,177.06
Rate for Payer: Vantage Medical Group Medi-Cal $863.18
Rate for Payer: Vantage Medical Group Senior $784.71
Service Code NDC 72607-100-00
Hospital Charge Code ERX226994
Hospital Revenue Code 259
Min. Negotiated Rate $16.06
Max. Negotiated Rate $66.55
Rate for Payer: Adventist Health Commercial $17.75
Rate for Payer: Aetna of CA Non-Gatekeeper $60.96
Rate for Payer: Cash Price $39.93
Rate for Payer: EPIC Health Plan Commercial $47.91
Rate for Payer: Heritage Provider Network Commercial $60.07
Rate for Payer: Heritage Provider Network Senior $60.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal $16.06
Rate for Payer: LLUH Dept of Risk Management WC $22.18
Rate for Payer: Multiplan Commercial $66.55
Service Code NDC 72607-100-00
Hospital Charge Code ERX226994
Hospital Revenue Code 259
Min. Negotiated Rate $16.06
Max. Negotiated Rate $75.42
Rate for Payer: Adventist Health Commercial $17.75
Rate for Payer: Aetna of CA Gatekeeper $47.43
Rate for Payer: Aetna of CA Non-Gatekeeper $60.96
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $75.42
Rate for Payer: AlphaCare Medical Group Medi-Cal $48.80
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $66.55
Rate for Payer: Blue Shield of California Commercial $55.10
Rate for Payer: Blue Shield of California EPN $52.08
Rate for Payer: Cash Price $39.93
Rate for Payer: Cigna of CA HMO/PPO $57.67
Rate for Payer: Dignity Health Commercial/Exchange $75.42
Rate for Payer: Dignity Health Medi-Cal $75.42
Rate for Payer: Dignity Health Senior $75.42
Rate for Payer: EPIC Health Plan Commercial $56.79
Rate for Payer: Heritage Provider Network Commercial $54.92
Rate for Payer: Heritage Provider Network Senior $54.92
Rate for Payer: Kaiser Permanente of CA Commercial $42.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal $16.06
Rate for Payer: LLUH Dept of Risk Management WC $22.18
Rate for Payer: Multiplan Commercial $66.55
Rate for Payer: Vantage Medical Group Medi-Cal $75.42
Rate for Payer: Vantage Medical Group Senior $75.42
Service Code CPT J9274
Hospital Charge Code NDG233477
Hospital Revenue Code 636
Min. Negotiated Rate $8,562.02
Max. Negotiated Rate $35,478.00
Rate for Payer: Adventist Health Commercial $9,460.80
Rate for Payer: Aetna of CA Non-Gatekeeper $32,497.85
Rate for Payer: Cash Price $21,286.80
Rate for Payer: Cigna of CA HMO/PPO $21,759.84
Rate for Payer: EPIC Health Plan Commercial $25,544.16
Rate for Payer: Heritage Provider Network Commercial $32,024.81
Rate for Payer: Heritage Provider Network Senior $32,024.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal $8,562.02
Rate for Payer: LLUH Dept of Risk Management WC $11,826.00
Rate for Payer: Multiplan Commercial $35,478.00
Rate for Payer: United Healthcare All Other HMO/non HMO $17,247.04
Rate for Payer: United Healthcare Navigate/Select/Select+ $15,804.27
Service Code CPT J9274
Hospital Charge Code NDG233477
Hospital Revenue Code 636
Min. Negotiated Rate $191.35
Max. Negotiated Rate $35,478.00
Rate for Payer: Adventist Health Commercial $9,460.80
Rate for Payer: Aetna of CA Gatekeeper $513.26
Rate for Payer: Aetna of CA Non-Gatekeeper $32,497.85
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $261.16
Rate for Payer: AlphaCare Medical Group Medi-Cal $229.82
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $229.82
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $400.87
Rate for Payer: Blue Shield of California Commercial $191.35
Rate for Payer: Blue Shield of California EPN $191.35
Rate for Payer: Cash Price $21,286.80
Rate for Payer: Cash Price $21,286.80
Rate for Payer: Cigna of CA HMO/PPO $21,759.84
Rate for Payer: Dignity Health Commercial/Exchange $261.16
Rate for Payer: Dignity Health Medi-Cal $229.82
Rate for Payer: Dignity Health Senior $229.82
Rate for Payer: EPIC Health Plan Commercial $30,274.56
Rate for Payer: EPIC Health Plan Medicare $208.93
Rate for Payer: Heritage Provider Network Commercial $21,901.75
Rate for Payer: Heritage Provider Network Senior $21,901.75
Rate for Payer: Humana Medicare $208.93
Rate for Payer: IEHP Medi-Cal $332.89
Rate for Payer: IEHP Medicare Advantage $208.93
Rate for Payer: Kaiser Permanente of CA Commercial $396.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal $8,562.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $246.53
Rate for Payer: LLUH Dept of Risk Management WC $11,826.00
Rate for Payer: Molina Healthcare of CA Medi-Cal $263.25
Rate for Payer: Molina Healthcare of CA Medicare $263.25
Rate for Payer: Multiplan Commercial $35,478.00
Rate for Payer: TriValley Medical Group Commercial $229.82
Rate for Payer: TriValley Medical Group Senior $208.93
Rate for Payer: United Healthcare All Other HMO/non HMO $17,247.04
Rate for Payer: United Healthcare Navigate/Select/Select+ $15,804.27
Rate for Payer: Vantage Medical Group Commercial/Exchange $261.16
Rate for Payer: Vantage Medical Group Medi-Cal $229.82
Rate for Payer: Vantage Medical Group Senior $229.82
Service Code CPT J9380
Hospital Charge Code NDG236039
Hospital Revenue Code 636
Min. Negotiated Rate $128.15
Max. Negotiated Rate $531.00
Rate for Payer: Adventist Health Commercial $141.60
Rate for Payer: Aetna of CA Non-Gatekeeper $486.40
Rate for Payer: Cash Price $318.60
Rate for Payer: Cigna of CA HMO/PPO $325.68
Rate for Payer: EPIC Health Plan Commercial $382.32
Rate for Payer: Heritage Provider Network Commercial $479.32
Rate for Payer: Heritage Provider Network Senior $479.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal $128.15
Rate for Payer: LLUH Dept of Risk Management WC $177.00
Rate for Payer: Multiplan Commercial $531.00
Rate for Payer: United Healthcare All Other HMO/non HMO $258.14
Rate for Payer: United Healthcare Navigate/Select/Select+ $236.54
Service Code CPT J9380
Hospital Charge Code NDG236039
Hospital Revenue Code 636
Min. Negotiated Rate $30.85
Max. Negotiated Rate $531.00
Rate for Payer: Adventist Health Commercial $141.60
Rate for Payer: Aetna of CA Gatekeeper $75.79
Rate for Payer: Aetna of CA Non-Gatekeeper $486.40
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $38.56
Rate for Payer: AlphaCare Medical Group Medi-Cal $33.93
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $33.93
Rate for Payer: Blue Shield of California Commercial $439.67
Rate for Payer: Blue Shield of California EPN $415.60
Rate for Payer: Cash Price $318.60
Rate for Payer: Cash Price $318.60
Rate for Payer: Cigna of CA HMO/PPO $325.68
Rate for Payer: Dignity Health Commercial/Exchange $38.56
Rate for Payer: Dignity Health Medi-Cal $33.93
Rate for Payer: Dignity Health Senior $33.93
Rate for Payer: EPIC Health Plan Commercial $453.12
Rate for Payer: EPIC Health Plan Medicare $30.85
Rate for Payer: Heritage Provider Network Commercial $327.80
Rate for Payer: Heritage Provider Network Senior $327.80
Rate for Payer: Humana Medicare $30.85
Rate for Payer: IEHP Medi-Cal $55.08
Rate for Payer: IEHP Medicare Advantage $30.85
Rate for Payer: Kaiser Permanente of CA Commercial $58.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal $128.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $36.40
Rate for Payer: LLUH Dept of Risk Management WC $177.00
Rate for Payer: Molina Healthcare of CA Medi-Cal $38.87
Rate for Payer: Molina Healthcare of CA Medicare $38.87
Rate for Payer: Multiplan Commercial $531.00
Rate for Payer: TriValley Medical Group Commercial $33.93
Rate for Payer: TriValley Medical Group Senior $30.85
Rate for Payer: United Healthcare All Other HMO/non HMO $258.14
Rate for Payer: United Healthcare Navigate/Select/Select+ $236.54
Rate for Payer: Vantage Medical Group Commercial/Exchange $38.56
Rate for Payer: Vantage Medical Group Medi-Cal $33.93
Rate for Payer: Vantage Medical Group Senior $33.93
Service Code CPT J9380
Hospital Charge Code NDG236038
Hospital Revenue Code 636
Min. Negotiated Rate $1,153.33
Max. Negotiated Rate $4,779.00
Rate for Payer: Adventist Health Commercial $1,274.40
Rate for Payer: Aetna of CA Non-Gatekeeper $4,377.56
Rate for Payer: Cash Price $2,867.40
Rate for Payer: Cigna of CA HMO/PPO $2,931.12
Rate for Payer: EPIC Health Plan Commercial $3,440.88
Rate for Payer: Heritage Provider Network Commercial $4,313.84
Rate for Payer: Heritage Provider Network Senior $4,313.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1,153.33
Rate for Payer: LLUH Dept of Risk Management WC $1,593.00
Rate for Payer: Multiplan Commercial $4,779.00
Rate for Payer: United Healthcare All Other HMO/non HMO $2,323.23
Rate for Payer: United Healthcare Navigate/Select/Select+ $2,128.89
Service Code CPT J9380
Hospital Charge Code NDG236038
Hospital Revenue Code 636
Min. Negotiated Rate $30.85
Max. Negotiated Rate $4,779.00
Rate for Payer: Adventist Health Commercial $1,274.40
Rate for Payer: Aetna of CA Gatekeeper $75.79
Rate for Payer: Aetna of CA Non-Gatekeeper $4,377.56
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $38.56
Rate for Payer: AlphaCare Medical Group Medi-Cal $33.93
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $33.93
Rate for Payer: Blue Shield of California Commercial $3,957.01
Rate for Payer: Blue Shield of California EPN $3,740.36
Rate for Payer: Cash Price $2,867.40
Rate for Payer: Cash Price $2,867.40
Rate for Payer: Cigna of CA HMO/PPO $2,931.12
Rate for Payer: Dignity Health Commercial/Exchange $38.56
Rate for Payer: Dignity Health Medi-Cal $33.93
Rate for Payer: Dignity Health Senior $33.93
Rate for Payer: EPIC Health Plan Commercial $4,078.08
Rate for Payer: EPIC Health Plan Medicare $30.85
Rate for Payer: Heritage Provider Network Commercial $2,950.24
Rate for Payer: Heritage Provider Network Senior $2,950.24
Rate for Payer: Humana Medicare $30.85
Rate for Payer: IEHP Medi-Cal $55.08
Rate for Payer: IEHP Medicare Advantage $30.85
Rate for Payer: Kaiser Permanente of CA Commercial $58.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1,153.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $36.40
Rate for Payer: LLUH Dept of Risk Management WC $1,593.00
Rate for Payer: Molina Healthcare of CA Medi-Cal $38.87
Rate for Payer: Molina Healthcare of CA Medicare $38.87
Rate for Payer: Multiplan Commercial $4,779.00
Rate for Payer: TriValley Medical Group Commercial $33.93
Rate for Payer: TriValley Medical Group Senior $30.85
Rate for Payer: United Healthcare All Other HMO/non HMO $2,323.23
Rate for Payer: United Healthcare Navigate/Select/Select+ $2,128.89
Rate for Payer: Vantage Medical Group Commercial/Exchange $38.56
Rate for Payer: Vantage Medical Group Medi-Cal $33.93
Rate for Payer: Vantage Medical Group Senior $33.93
Service Code CPT J3090
Hospital Charge Code ERX206225
Hospital Revenue Code 636
Min. Negotiated Rate $66.84
Max. Negotiated Rate $276.97
Rate for Payer: Adventist Health Commercial $73.86
Rate for Payer: Aetna of CA Non-Gatekeeper $253.70
Rate for Payer: Cash Price $166.18
Rate for Payer: Cigna of CA HMO/PPO $169.87
Rate for Payer: EPIC Health Plan Commercial $199.42
Rate for Payer: Heritage Provider Network Commercial $250.01
Rate for Payer: Heritage Provider Network Senior $250.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal $66.84
Rate for Payer: LLUH Dept of Risk Management WC $92.32
Rate for Payer: Multiplan Commercial $276.97
Rate for Payer: United Healthcare All Other HMO/non HMO $134.64
Rate for Payer: United Healthcare Navigate/Select/Select+ $123.38
Service Code CPT J3090
Hospital Charge Code ERX206225
Hospital Revenue Code 636
Min. Negotiated Rate $1.72
Max. Negotiated Rate $276.97
Rate for Payer: Adventist Health Commercial $73.86
Rate for Payer: Aetna of CA Gatekeeper $4.38
Rate for Payer: Aetna of CA Non-Gatekeeper $253.70
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $2.23
Rate for Payer: AlphaCare Medical Group Medi-Cal $1.96
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $1.96
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $2.49
Rate for Payer: Blue Shield of California Commercial $1.72
Rate for Payer: Blue Shield of California EPN $1.72
Rate for Payer: Cash Price $166.18
Rate for Payer: Cash Price $166.18
Rate for Payer: Cigna of CA HMO/PPO $169.87
Rate for Payer: Dignity Health Commercial/Exchange $2.67
Rate for Payer: Dignity Health Medi-Cal $1.96
Rate for Payer: Dignity Health Senior $1.96
Rate for Payer: EPIC Health Plan Commercial $236.35
Rate for Payer: EPIC Health Plan Medicare $1.78
Rate for Payer: Heritage Provider Network Commercial $170.98
Rate for Payer: Heritage Provider Network Senior $170.98
Rate for Payer: Humana Medicare $1.78
Rate for Payer: IEHP Medi-Cal $9.73
Rate for Payer: IEHP Medicare Advantage $1.78
Rate for Payer: Kaiser Permanente of CA Commercial $3.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal $66.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $2.10
Rate for Payer: LLUH Dept of Risk Management WC $92.32
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 $276.97
Rate for Payer: TriValley Medical Group Commercial $1.96
Rate for Payer: TriValley Medical Group Senior $1.78
Rate for Payer: United Healthcare All Other HMO/non HMO $134.64
Rate for Payer: United Healthcare Navigate/Select/Select+ $123.38
Rate for Payer: Vantage Medical Group Commercial/Exchange $2.67
Rate for Payer: Vantage Medical Group Medi-Cal $1.96
Rate for Payer: Vantage Medical Group Senior $1.78
Service Code NDC 0597-0040-37
Hospital Charge Code 1710970
Hospital Revenue Code 259
Min. Negotiated Rate $1.02
Max. Negotiated Rate $4.77
Rate for Payer: Adventist Health Commercial $1.12
Rate for Payer: Aetna of CA Gatekeeper $3.00
Rate for Payer: Aetna of CA Non-Gatekeeper $3.85
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $4.77
Rate for Payer: AlphaCare Medical Group Medi-Cal $3.09
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $4.21
Rate for Payer: Blue Shield of California Commercial $3.48
Rate for Payer: Blue Shield of California EPN $3.29
Rate for Payer: Cash Price $2.52
Rate for Payer: Cigna of CA HMO/PPO $3.65
Rate for Payer: Dignity Health Commercial/Exchange $4.77
Rate for Payer: Dignity Health Medi-Cal $4.77
Rate for Payer: Dignity Health Senior $4.77
Rate for Payer: EPIC Health Plan Commercial $3.59
Rate for Payer: Heritage Provider Network Commercial $3.47
Rate for Payer: Heritage Provider Network Senior $3.47
Rate for Payer: Kaiser Permanente of CA Commercial $2.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.02
Rate for Payer: LLUH Dept of Risk Management WC $1.40
Rate for Payer: Multiplan Commercial $4.21
Rate for Payer: Vantage Medical Group Medi-Cal $4.77
Rate for Payer: Vantage Medical Group Senior $4.77
Service Code NDC 0597-0040-37
Hospital Charge Code 1710970
Hospital Revenue Code 259
Min. Negotiated Rate $1.02
Max. Negotiated Rate $4.21
Rate for Payer: Adventist Health Commercial $1.12
Rate for Payer: Aetna of CA Non-Gatekeeper $3.85
Rate for Payer: Cash Price $2.52
Rate for Payer: EPIC Health Plan Commercial $3.03
Rate for Payer: Heritage Provider Network Commercial $3.80
Rate for Payer: Heritage Provider Network Senior $3.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.02
Rate for Payer: LLUH Dept of Risk Management WC $1.40
Rate for Payer: Multiplan Commercial $4.21
Service Code NDC 0597-0041-37
Hospital Charge Code 1710961
Hospital Revenue Code 259
Min. Negotiated Rate $1.02
Max. Negotiated Rate $4.77
Rate for Payer: Adventist Health Commercial $1.12
Rate for Payer: Aetna of CA Gatekeeper $3.00
Rate for Payer: Aetna of CA Non-Gatekeeper $3.85
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $4.77
Rate for Payer: AlphaCare Medical Group Medi-Cal $3.09
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $4.21
Rate for Payer: Blue Shield of California Commercial $3.48
Rate for Payer: Blue Shield of California EPN $3.29
Rate for Payer: Cash Price $2.52
Rate for Payer: Cigna of CA HMO/PPO $3.65
Rate for Payer: Dignity Health Commercial/Exchange $4.77
Rate for Payer: Dignity Health Medi-Cal $4.77
Rate for Payer: Dignity Health Senior $4.77
Rate for Payer: EPIC Health Plan Commercial $3.59
Rate for Payer: Heritage Provider Network Commercial $3.47
Rate for Payer: Heritage Provider Network Senior $3.47
Rate for Payer: Kaiser Permanente of CA Commercial $2.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.02
Rate for Payer: LLUH Dept of Risk Management WC $1.40
Rate for Payer: Multiplan Commercial $4.21
Rate for Payer: Vantage Medical Group Medi-Cal $4.77
Rate for Payer: Vantage Medical Group Senior $4.77