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Charge Type Price  
Service Code NDC 0487-9901-30
Hospital Charge Code 1781093
Hospital Revenue Code 259
Min. Negotiated Rate $0.78
Max. Negotiated Rate $3.24
Rate for Payer: Adventist Health Commercial $0.86
Rate for Payer: Aetna of CA Non-Gatekeeper $2.97
Rate for Payer: Cash Price $1.94
Rate for Payer: EPIC Health Plan Commercial $2.33
Rate for Payer: Heritage Provider Network Commercial $2.92
Rate for Payer: Heritage Provider Network Senior $2.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.78
Rate for Payer: LLUH Dept of Risk Management WC $1.08
Rate for Payer: Multiplan Commercial $3.24
Service Code NDC 50383-741-20
Hospital Charge Code 1744054
Hospital Revenue Code 259
Min. Negotiated Rate $0.52
Max. Negotiated Rate $2.46
Rate for Payer: Adventist Health Commercial $0.58
Rate for Payer: Aetna of CA Gatekeeper $1.55
Rate for Payer: Aetna of CA Non-Gatekeeper $1.99
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $2.46
Rate for Payer: AlphaCare Medical Group Medi-Cal $1.60
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $2.18
Rate for Payer: Blue Shield of California Commercial $1.80
Rate for Payer: Blue Shield of California EPN $1.70
Rate for Payer: Cash Price $1.31
Rate for Payer: Cigna of CA HMO/PPO $1.88
Rate for Payer: Dignity Health Commercial/Exchange $2.46
Rate for Payer: Dignity Health Medi-Cal $2.46
Rate for Payer: Dignity Health Senior $2.46
Rate for Payer: EPIC Health Plan Commercial $1.86
Rate for Payer: Heritage Provider Network Commercial $1.80
Rate for Payer: Heritage Provider Network Senior $1.80
Rate for Payer: Kaiser Permanente of CA Commercial $1.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.52
Rate for Payer: LLUH Dept of Risk Management WC $0.73
Rate for Payer: Multiplan Commercial $2.18
Rate for Payer: Vantage Medical Group Medi-Cal $2.46
Rate for Payer: Vantage Medical Group Senior $2.46
Service Code NDC 50383-741-20
Hospital Charge Code 1744054
Hospital Revenue Code 259
Min. Negotiated Rate $0.52
Max. Negotiated Rate $2.18
Rate for Payer: Adventist Health Commercial $0.58
Rate for Payer: Aetna of CA Non-Gatekeeper $1.99
Rate for Payer: Cash Price $1.31
Rate for Payer: EPIC Health Plan Commercial $1.57
Rate for Payer: Heritage Provider Network Commercial $1.96
Rate for Payer: Heritage Provider Network Senior $1.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.52
Rate for Payer: LLUH Dept of Risk Management WC $0.73
Rate for Payer: Multiplan Commercial $2.18
Service Code NDC 73177-146-33
Hospital Charge Code 1744054
Hospital Revenue Code 259
Min. Negotiated Rate $0.54
Max. Negotiated Rate $2.25
Rate for Payer: Adventist Health Commercial $0.60
Rate for Payer: Aetna of CA Non-Gatekeeper $2.06
Rate for Payer: Cash Price $1.35
Rate for Payer: EPIC Health Plan Commercial $1.62
Rate for Payer: Heritage Provider Network Commercial $2.03
Rate for Payer: Heritage Provider Network Senior $2.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.54
Rate for Payer: LLUH Dept of Risk Management WC $0.75
Rate for Payer: Multiplan Commercial $2.25
Service Code NDC 73177-146-33
Hospital Charge Code 1744054
Hospital Revenue Code 259
Min. Negotiated Rate $0.54
Max. Negotiated Rate $2.55
Rate for Payer: Adventist Health Commercial $0.60
Rate for Payer: Aetna of CA Gatekeeper $1.60
Rate for Payer: Aetna of CA Non-Gatekeeper $2.06
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $2.55
Rate for Payer: AlphaCare Medical Group Medi-Cal $1.65
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $2.25
Rate for Payer: Blue Shield of California Commercial $1.86
Rate for Payer: Blue Shield of California EPN $1.76
Rate for Payer: Cash Price $1.35
Rate for Payer: Cigna of CA HMO/PPO $1.95
Rate for Payer: Dignity Health Commercial/Exchange $2.55
Rate for Payer: Dignity Health Medi-Cal $2.55
Rate for Payer: Dignity Health Senior $2.55
Rate for Payer: EPIC Health Plan Commercial $1.92
Rate for Payer: Heritage Provider Network Commercial $1.86
Rate for Payer: Heritage Provider Network Senior $1.86
Rate for Payer: Kaiser Permanente of CA Commercial $1.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.54
Rate for Payer: LLUH Dept of Risk Management WC $0.75
Rate for Payer: Multiplan Commercial $2.25
Rate for Payer: Vantage Medical Group Medi-Cal $2.55
Rate for Payer: Vantage Medical Group Senior $2.55
Service Code NDC 68180-963-01
Hospital Charge Code 1744112
Hospital Revenue Code 259
Min. Negotiated Rate $0.92
Max. Negotiated Rate $3.81
Rate for Payer: Adventist Health Commercial $1.02
Rate for Payer: Aetna of CA Non-Gatekeeper $3.49
Rate for Payer: Cash Price $2.29
Rate for Payer: EPIC Health Plan Commercial $2.74
Rate for Payer: Heritage Provider Network Commercial $3.44
Rate for Payer: Heritage Provider Network Senior $3.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.92
Rate for Payer: LLUH Dept of Risk Management WC $1.27
Rate for Payer: Multiplan Commercial $3.81
Service Code NDC 0173-0682-24
Hospital Charge Code 1744126
Hospital Revenue Code 259
Min. Negotiated Rate $0.62
Max. Negotiated Rate $2.90
Rate for Payer: Adventist Health Commercial $0.68
Rate for Payer: Aetna of CA Gatekeeper $1.82
Rate for Payer: Aetna of CA Non-Gatekeeper $2.34
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $2.90
Rate for Payer: AlphaCare Medical Group Medi-Cal $1.88
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $2.56
Rate for Payer: Blue Shield of California Commercial $2.12
Rate for Payer: Blue Shield of California EPN $2.00
Rate for Payer: Cash Price $1.53
Rate for Payer: Cigna of CA HMO/PPO $2.22
Rate for Payer: Dignity Health Commercial/Exchange $2.90
Rate for Payer: Dignity Health Medi-Cal $2.90
Rate for Payer: Dignity Health Senior $2.90
Rate for Payer: EPIC Health Plan Commercial $2.18
Rate for Payer: Heritage Provider Network Commercial $2.11
Rate for Payer: Heritage Provider Network Senior $2.11
Rate for Payer: Kaiser Permanente of CA Commercial $1.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.62
Rate for Payer: LLUH Dept of Risk Management WC $0.85
Rate for Payer: Multiplan Commercial $2.56
Rate for Payer: Vantage Medical Group Medi-Cal $2.90
Rate for Payer: Vantage Medical Group Senior $2.90
Service Code NDC 0173-0682-24
Hospital Charge Code 1744126
Hospital Revenue Code 259
Min. Negotiated Rate $0.62
Max. Negotiated Rate $2.56
Rate for Payer: Adventist Health Commercial $0.68
Rate for Payer: Aetna of CA Non-Gatekeeper $2.34
Rate for Payer: Cash Price $1.53
Rate for Payer: EPIC Health Plan Commercial $1.84
Rate for Payer: Heritage Provider Network Commercial $2.31
Rate for Payer: Heritage Provider Network Senior $2.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.62
Rate for Payer: LLUH Dept of Risk Management WC $0.85
Rate for Payer: Multiplan Commercial $2.56
Service Code NDC 68180-963-01
Hospital Charge Code 1744112
Hospital Revenue Code 259
Min. Negotiated Rate $0.92
Max. Negotiated Rate $4.32
Rate for Payer: Adventist Health Commercial $1.02
Rate for Payer: Aetna of CA Gatekeeper $2.72
Rate for Payer: Aetna of CA Non-Gatekeeper $3.49
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $4.32
Rate for Payer: AlphaCare Medical Group Medi-Cal $2.79
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $3.81
Rate for Payer: Blue Shield of California Commercial $3.15
Rate for Payer: Blue Shield of California EPN $2.98
Rate for Payer: Cash Price $2.29
Rate for Payer: Cigna of CA HMO/PPO $3.30
Rate for Payer: Dignity Health Commercial/Exchange $4.32
Rate for Payer: Dignity Health Medi-Cal $4.32
Rate for Payer: Dignity Health Senior $4.32
Rate for Payer: EPIC Health Plan Commercial $3.25
Rate for Payer: Heritage Provider Network Commercial $3.14
Rate for Payer: Heritage Provider Network Senior $3.14
Rate for Payer: Kaiser Permanente of CA Commercial $2.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.92
Rate for Payer: LLUH Dept of Risk Management WC $1.27
Rate for Payer: Multiplan Commercial $3.81
Rate for Payer: Vantage Medical Group Medi-Cal $4.32
Rate for Payer: Vantage Medical Group Senior $4.32
Service Code APR-DRG 7751
Min. Negotiated Rate $3,325.94
Max. Negotiated Rate $3,325.94
Rate for Payer: IEHP Medi-Cal $3,325.94
Service Code APR-DRG 7752
Min. Negotiated Rate $4,555.62
Max. Negotiated Rate $4,555.62
Rate for Payer: IEHP Medi-Cal $4,555.62
Service Code APR-DRG 7753
Min. Negotiated Rate $7,753.22
Max. Negotiated Rate $7,753.22
Rate for Payer: IEHP Medi-Cal $7,753.22
Service Code APR-DRG 7754
Min. Negotiated Rate $17,173.89
Max. Negotiated Rate $17,173.89
Rate for Payer: IEHP Medi-Cal $17,173.89
Service Code APR-DRG 7724
Min. Negotiated Rate $16,099.41
Max. Negotiated Rate $16,099.41
Rate for Payer: IEHP Medi-Cal $16,099.41
Service Code APR-DRG 7722
Min. Negotiated Rate $4,979.46
Max. Negotiated Rate $4,979.46
Rate for Payer: IEHP Medi-Cal $4,979.46
Service Code APR-DRG 7723
Min. Negotiated Rate $6,097.71
Max. Negotiated Rate $6,097.71
Rate for Payer: IEHP Medi-Cal $6,097.71
Service Code APR-DRG 7721
Min. Negotiated Rate $4,050.23
Max. Negotiated Rate $4,050.23
Rate for Payer: IEHP Medi-Cal $4,050.23
Service Code APR-DRG 2803
Min. Negotiated Rate $8,905.31
Max. Negotiated Rate $8,905.31
Rate for Payer: IEHP Medi-Cal $8,905.31
Service Code APR-DRG 2801
Min. Negotiated Rate $4,532.75
Max. Negotiated Rate $4,532.75
Rate for Payer: IEHP Medi-Cal $4,532.75
Service Code APR-DRG 2804
Min. Negotiated Rate $18,729.91
Max. Negotiated Rate $18,729.91
Rate for Payer: IEHP Medi-Cal $18,729.91
Service Code APR-DRG 2802
Min. Negotiated Rate $5,848.99
Max. Negotiated Rate $5,848.99
Rate for Payer: IEHP Medi-Cal $5,848.99
Service Code NDC 50242-130-01
Hospital Charge Code ERX212384
Hospital Revenue Code 259
Min. Negotiated Rate $15.83
Max. Negotiated Rate $65.59
Rate for Payer: Adventist Health Commercial $17.49
Rate for Payer: Aetna of CA Non-Gatekeeper $60.08
Rate for Payer: Cash Price $39.35
Rate for Payer: EPIC Health Plan Commercial $47.22
Rate for Payer: Heritage Provider Network Commercial $59.20
Rate for Payer: Heritage Provider Network Senior $59.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal $15.83
Rate for Payer: LLUH Dept of Risk Management WC $21.86
Rate for Payer: Multiplan Commercial $65.59
Service Code NDC 50242-130-01
Hospital Charge Code ERX212384
Hospital Revenue Code 259
Min. Negotiated Rate $15.83
Max. Negotiated Rate $74.33
Rate for Payer: Adventist Health Commercial $17.49
Rate for Payer: Aetna of CA Gatekeeper $46.74
Rate for Payer: Aetna of CA Non-Gatekeeper $60.08
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $74.33
Rate for Payer: AlphaCare Medical Group Medi-Cal $48.10
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $65.59
Rate for Payer: Blue Shield of California Commercial $54.31
Rate for Payer: Blue Shield of California EPN $51.33
Rate for Payer: Cash Price $39.35
Rate for Payer: Cigna of CA HMO/PPO $56.84
Rate for Payer: Dignity Health Commercial/Exchange $74.33
Rate for Payer: Dignity Health Medi-Cal $74.33
Rate for Payer: Dignity Health Senior $74.33
Rate for Payer: EPIC Health Plan Commercial $55.97
Rate for Payer: Heritage Provider Network Commercial $54.13
Rate for Payer: Heritage Provider Network Senior $54.13
Rate for Payer: Kaiser Permanente of CA Commercial $42.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal $15.83
Rate for Payer: LLUH Dept of Risk Management WC $21.86
Rate for Payer: Multiplan Commercial $65.59
Rate for Payer: Vantage Medical Group Medi-Cal $74.33
Rate for Payer: Vantage Medical Group Senior $74.33
Service Code CPT J0202
Hospital Charge Code NDG208005
Hospital Revenue Code 636
Min. Negotiated Rate $5,212.47
Max. Negotiated Rate $21,598.64
Rate for Payer: Adventist Health Commercial $5,759.64
Rate for Payer: Aetna of CA Non-Gatekeeper $19,784.35
Rate for Payer: Cash Price $12,959.18
Rate for Payer: Cigna of CA HMO/PPO $13,247.16
Rate for Payer: EPIC Health Plan Commercial $15,551.02
Rate for Payer: Heritage Provider Network Commercial $19,496.37
Rate for Payer: Heritage Provider Network Senior $19,496.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal $5,212.47
Rate for Payer: LLUH Dept of Risk Management WC $7,199.54
Rate for Payer: Multiplan Commercial $21,598.64
Rate for Payer: United Healthcare All Other HMO/non HMO $10,499.82
Rate for Payer: United Healthcare Navigate/Select/Select+ $9,621.47
Service Code CPT J0202
Hospital Charge Code NDG208005
Hospital Revenue Code 636
Min. Negotiated Rate $2,301.13
Max. Negotiated Rate $21,598.64
Rate for Payer: Adventist Health Commercial $5,759.64
Rate for Payer: Aetna of CA Gatekeeper $5,710.04
Rate for Payer: Aetna of CA Non-Gatekeeper $19,784.35
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $2,905.43
Rate for Payer: AlphaCare Medical Group Medi-Cal $2,556.78
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $2,556.78
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,517.34
Rate for Payer: Blue Shield of California Commercial $2,301.13
Rate for Payer: Blue Shield of California EPN $2,301.13
Rate for Payer: Cash Price $12,959.18
Rate for Payer: Cash Price $12,959.18
Rate for Payer: Cigna of CA HMO/PPO $13,247.16
Rate for Payer: Dignity Health Commercial/Exchange $3,486.52
Rate for Payer: Dignity Health Medi-Cal $2,556.78
Rate for Payer: Dignity Health Senior $2,556.78
Rate for Payer: EPIC Health Plan Commercial $18,430.84
Rate for Payer: EPIC Health Plan Medicare $2,324.34
Rate for Payer: Heritage Provider Network Commercial $13,333.56
Rate for Payer: Heritage Provider Network Senior $13,333.56
Rate for Payer: Humana Medicare $2,324.34
Rate for Payer: IEHP Medi-Cal $3,632.93
Rate for Payer: IEHP Medicare Advantage $2,324.34
Rate for Payer: Kaiser Permanente of CA Commercial $4,416.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal $5,212.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $2,742.73
Rate for Payer: LLUH Dept of Risk Management WC $7,199.54
Rate for Payer: Molina Healthcare of CA Medi-Cal $2,928.67
Rate for Payer: Molina Healthcare of CA Medicare $2,928.67
Rate for Payer: Multiplan Commercial $21,598.64
Rate for Payer: TriValley Medical Group Commercial $2,556.78
Rate for Payer: TriValley Medical Group Senior $2,324.34
Rate for Payer: United Healthcare All Other HMO/non HMO $10,499.82
Rate for Payer: United Healthcare Navigate/Select/Select+ $9,621.47
Rate for Payer: Vantage Medical Group Commercial/Exchange $3,486.52
Rate for Payer: Vantage Medical Group Medi-Cal $2,556.78
Rate for Payer: Vantage Medical Group Senior $2,324.34