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Service Code NDC 0904-7727-14
Hospital Charge Code 1719042
Hospital Revenue Code 259
Max. Negotiated Rate $0.02
Rate for Payer: Adventist Health Commercial $0.00
Rate for Payer: Aetna of CA Gatekeeper $0.01
Rate for Payer: Aetna of CA Non-Gatekeeper $0.01
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.02
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.01
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.02
Rate for Payer: Blue Shield of California Commercial $0.01
Rate for Payer: Blue Shield of California EPN $0.01
Rate for Payer: Cash Price $0.01
Rate for Payer: Cigna of CA HMO/PPO $0.01
Rate for Payer: Dignity Health Commercial/Exchange $0.02
Rate for Payer: Dignity Health Medi-Cal $0.02
Rate for Payer: Dignity Health Senior $0.02
Rate for Payer: EPIC Health Plan Commercial $0.01
Rate for Payer: Heritage Provider Network Commercial $0.01
Rate for Payer: Heritage Provider Network Senior $0.01
Rate for Payer: Kaiser Permanente of CA Commercial $0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.00
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.02
Rate for Payer: Vantage Medical Group Medi-Cal $0.02
Rate for Payer: Vantage Medical Group Senior $0.02
Service Code NDC 0904-7727-14
Hospital Charge Code 1719042
Hospital Revenue Code 259
Max. Negotiated Rate $0.02
Rate for Payer: Adventist Health Commercial $0.00
Rate for Payer: Aetna of CA Non-Gatekeeper $0.01
Rate for Payer: Cash Price $0.01
Rate for Payer: EPIC Health Plan Commercial $0.01
Rate for Payer: Heritage Provider Network Commercial $0.01
Rate for Payer: Heritage Provider Network Senior $0.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.00
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.02
Service Code NDC 0121-1761-30
Hospital Charge Code 1716045
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.11
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Aetna of CA Gatekeeper $0.07
Rate for Payer: Aetna of CA Non-Gatekeeper $0.09
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.11
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.07
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.10
Rate for Payer: Blue Shield of California Commercial $0.08
Rate for Payer: Blue Shield of California EPN $0.08
Rate for Payer: Cash Price $0.06
Rate for Payer: Cigna of CA HMO/PPO $0.08
Rate for Payer: Dignity Health Commercial/Exchange $0.11
Rate for Payer: Dignity Health Medi-Cal $0.11
Rate for Payer: Dignity Health Senior $0.11
Rate for Payer: EPIC Health Plan Commercial $0.08
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 Commercial $0.06
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 $0.10
Rate for Payer: Vantage Medical Group Medi-Cal $0.11
Rate for Payer: Vantage Medical Group Senior $0.11
Service Code NDC 0121-1761-30
Hospital Charge Code 1716045
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.10
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Aetna of CA Non-Gatekeeper $0.09
Rate for Payer: Cash Price $0.06
Rate for Payer: EPIC Health Plan Commercial $0.07
Rate for Payer: Heritage Provider Network Commercial $0.09
Rate for Payer: Heritage Provider Network Senior $0.09
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 $0.10
Service Code NDC 0121-1762-30
Hospital Charge Code NDG9015
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.10
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Aetna of CA Non-Gatekeeper $0.09
Rate for Payer: Cash Price $0.06
Rate for Payer: EPIC Health Plan Commercial $0.07
Rate for Payer: Heritage Provider Network Commercial $0.09
Rate for Payer: Heritage Provider Network Senior $0.09
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 $0.10
Service Code NDC 0121-1762-30
Hospital Charge Code NDG9015
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.11
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Aetna of CA Gatekeeper $0.07
Rate for Payer: Aetna of CA Non-Gatekeeper $0.09
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.11
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.07
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.10
Rate for Payer: Blue Shield of California Commercial $0.08
Rate for Payer: Blue Shield of California EPN $0.08
Rate for Payer: Cash Price $0.06
Rate for Payer: Cigna of CA HMO/PPO $0.08
Rate for Payer: Dignity Health Commercial/Exchange $0.11
Rate for Payer: Dignity Health Medi-Cal $0.11
Rate for Payer: Dignity Health Senior $0.11
Rate for Payer: EPIC Health Plan Commercial $0.08
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 Commercial $0.06
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 $0.10
Rate for Payer: Vantage Medical Group Medi-Cal $0.11
Rate for Payer: Vantage Medical Group Senior $0.11
Service Code NDC 0121-1760-30
Hospital Charge Code 1719150
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.13
Rate for Payer: Adventist Health Commercial $0.03
Rate for Payer: Aetna of CA Gatekeeper $0.08
Rate for Payer: Aetna of CA Non-Gatekeeper $0.10
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.13
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.08
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.11
Rate for Payer: Blue Shield of California Commercial $0.09
Rate for Payer: Blue Shield of California EPN $0.09
Rate for Payer: Cash Price $0.07
Rate for Payer: Cigna of CA HMO/PPO $0.10
Rate for Payer: Dignity Health Commercial/Exchange $0.13
Rate for Payer: Dignity Health Medi-Cal $0.13
Rate for Payer: Dignity Health Senior $0.13
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Heritage Provider Network Commercial $0.09
Rate for Payer: Heritage Provider Network Senior $0.09
Rate for Payer: Kaiser Permanente of CA Commercial $0.07
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
Rate for Payer: Vantage Medical Group Medi-Cal $0.13
Rate for Payer: Vantage Medical Group Senior $0.13
Service Code NDC 0121-1760-30
Hospital Charge Code 1719150
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 CPT 41874
Min. Negotiated Rate $299.10
Max. Negotiated Rate $9,616.00
Rate for Payer: Aetna of CA Gatekeeper $1,335.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $6,034.04
Rate for Payer: AlphaCare Medical Group Medi-Cal $4,424.96
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $4,022.69
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,547.00
Rate for Payer: Dignity Health Commercial/Exchange $6,034.04
Rate for Payer: Dignity Health Medi-Cal $4,424.96
Rate for Payer: Dignity Health Senior $4,022.69
Rate for Payer: EPIC Health Plan Commercial $9,616.00
Rate for Payer: EPIC Health Plan Medicare $4,022.69
Rate for Payer: Humana Medicare $4,022.69
Rate for Payer: IEHP Medi-Cal $299.10
Rate for Payer: IEHP Medicare Advantage $4,022.69
Rate for Payer: Kaiser Permanente of CA Commercial $7,643.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $4,746.77
Rate for Payer: Molina Healthcare of CA Medi-Cal $5,068.59
Rate for Payer: Molina Healthcare of CA Medicare $5,068.59
Rate for Payer: TriValley Medical Group Commercial $4,424.96
Rate for Payer: TriValley Medical Group Senior $4,022.69
Rate for Payer: Vantage Medical Group Commercial/Exchange $6,034.04
Rate for Payer: Vantage Medical Group Medi-Cal $4,424.96
Rate for Payer: Vantage Medical Group Senior $4,022.69
Service Code NDC 67919-020-10
Hospital Charge Code ERX91870
Hospital Revenue Code 271
Min. Negotiated Rate $39.50
Max. Negotiated Rate $163.66
Rate for Payer: Adventist Health Commercial $43.64
Rate for Payer: Aetna of CA Non-Gatekeeper $149.91
Rate for Payer: Cash Price $98.19
Rate for Payer: Heritage Provider Network Commercial $147.73
Rate for Payer: Heritage Provider Network Senior $147.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $39.50
Rate for Payer: LLUH Dept of Risk Management WC $54.55
Rate for Payer: Multiplan Commercial $163.66
Service Code NDC 67919-020-10
Hospital Charge Code ERX91870
Hospital Revenue Code 271
Min. Negotiated Rate $39.50
Max. Negotiated Rate $185.48
Rate for Payer: Adventist Health Commercial $43.64
Rate for Payer: Aetna of CA Gatekeeper $116.63
Rate for Payer: Aetna of CA Non-Gatekeeper $149.91
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $185.48
Rate for Payer: AlphaCare Medical Group Medi-Cal $120.02
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $163.66
Rate for Payer: Blue Shield of California Commercial $135.51
Rate for Payer: Blue Shield of California EPN $128.09
Rate for Payer: Cash Price $98.19
Rate for Payer: Cigna of CA HMO/PPO $141.84
Rate for Payer: Dignity Health Commercial/Exchange $185.48
Rate for Payer: Dignity Health Medi-Cal $185.48
Rate for Payer: Dignity Health Senior $185.48
Rate for Payer: EPIC Health Plan Commercial $141.84
Rate for Payer: Heritage Provider Network Commercial $135.07
Rate for Payer: Heritage Provider Network Senior $135.07
Rate for Payer: Kaiser Permanente of CA Commercial $105.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal $39.50
Rate for Payer: LLUH Dept of Risk Management WC $54.55
Rate for Payer: Multiplan Commercial $163.66
Rate for Payer: Vantage Medical Group Medi-Cal $185.48
Rate for Payer: Vantage Medical Group Senior $185.48
Service Code NDC 16571-834-01
Hospital Charge Code 1710713
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 Gatekeeper $0.06
Rate for Payer: Aetna of CA Non-Gatekeeper $0.08
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.10
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.07
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.09
Rate for Payer: Blue Shield of California Commercial $0.07
Rate for Payer: Blue Shield of California EPN $0.07
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 Senior $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 Permanente of CA Commercial $0.06
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
Rate for Payer: Vantage Medical Group Medi-Cal $0.10
Rate for Payer: Vantage Medical Group Senior $0.10
Service Code NDC 42543-493-01
Hospital Charge Code 1710713
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.36
Rate for Payer: Adventist Health Commercial $0.10
Rate for Payer: Aetna of CA Non-Gatekeeper $0.33
Rate for Payer: Cash Price $0.22
Rate for Payer: EPIC Health Plan Commercial $0.26
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 $0.36
Service Code NDC 68382-512-01
Hospital Charge Code 1710713
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.73
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Aetna of CA Non-Gatekeeper $0.67
Rate for Payer: Cash Price $0.44
Rate for Payer: EPIC Health Plan Commercial $0.52
Rate for Payer: Heritage Provider Network Commercial $0.66
Rate for Payer: Heritage Provider Network Senior $0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.18
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.73
Service Code NDC 16571-834-01
Hospital Charge Code 1710713
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
Service Code NDC 68382-512-01
Hospital Charge Code 1710713
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.82
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Aetna of CA Gatekeeper $0.52
Rate for Payer: Aetna of CA Non-Gatekeeper $0.67
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.82
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.53
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.73
Rate for Payer: Blue Shield of California Commercial $0.60
Rate for Payer: Blue Shield of California EPN $0.57
Rate for Payer: Cash Price $0.44
Rate for Payer: Cigna of CA HMO/PPO $0.63
Rate for Payer: Dignity Health Commercial/Exchange $0.82
Rate for Payer: Dignity Health Medi-Cal $0.82
Rate for Payer: Dignity Health Senior $0.82
Rate for Payer: EPIC Health Plan Commercial $0.62
Rate for Payer: Heritage Provider Network Commercial $0.60
Rate for Payer: Heritage Provider Network Senior $0.60
Rate for Payer: Kaiser Permanente of CA Commercial $0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.18
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.73
Rate for Payer: Vantage Medical Group Medi-Cal $0.82
Rate for Payer: Vantage Medical Group Senior $0.82
Service Code NDC 0832-1015-00
Hospital Charge Code 1710713
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.73
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Aetna of CA Non-Gatekeeper $0.67
Rate for Payer: Cash Price $0.44
Rate for Payer: EPIC Health Plan Commercial $0.52
Rate for Payer: Heritage Provider Network Commercial $0.66
Rate for Payer: Heritage Provider Network Senior $0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.18
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.73
Service Code NDC 0832-1015-00
Hospital Charge Code 1710713
Hospital Revenue Code 259
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.82
Rate for Payer: Adventist Health Commercial $0.19
Rate for Payer: Aetna of CA Gatekeeper $0.52
Rate for Payer: Aetna of CA Non-Gatekeeper $0.67
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.82
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.53
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.73
Rate for Payer: Blue Shield of California Commercial $0.60
Rate for Payer: Blue Shield of California EPN $0.57
Rate for Payer: Cash Price $0.44
Rate for Payer: Cigna of CA HMO/PPO $0.63
Rate for Payer: Dignity Health Commercial/Exchange $0.82
Rate for Payer: Dignity Health Medi-Cal $0.82
Rate for Payer: Dignity Health Senior $0.82
Rate for Payer: EPIC Health Plan Commercial $0.62
Rate for Payer: Heritage Provider Network Commercial $0.60
Rate for Payer: Heritage Provider Network Senior $0.60
Rate for Payer: Kaiser Permanente of CA Commercial $0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.18
Rate for Payer: LLUH Dept of Risk Management WC $0.24
Rate for Payer: Multiplan Commercial $0.73
Rate for Payer: Vantage Medical Group Medi-Cal $0.82
Rate for Payer: Vantage Medical Group Senior $0.82
Service Code NDC 42543-493-01
Hospital Charge Code 1710713
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.41
Rate for Payer: Adventist Health Commercial $0.10
Rate for Payer: Aetna of CA Gatekeeper $0.26
Rate for Payer: Aetna of CA Non-Gatekeeper $0.33
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $0.41
Rate for Payer: AlphaCare Medical Group Medi-Cal $0.26
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $0.36
Rate for Payer: Blue Shield of California Commercial $0.30
Rate for Payer: Blue Shield of California EPN $0.28
Rate for Payer: Cash Price $0.22
Rate for Payer: Cigna of CA HMO/PPO $0.31
Rate for Payer: Dignity Health Commercial/Exchange $0.41
Rate for Payer: Dignity Health Medi-Cal $0.41
Rate for Payer: Dignity Health Senior $0.41
Rate for Payer: EPIC Health Plan Commercial $0.31
Rate for Payer: Heritage Provider Network Commercial $0.30
Rate for Payer: Heritage Provider Network Senior $0.30
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 $0.36
Rate for Payer: Vantage Medical Group Medi-Cal $0.41
Rate for Payer: Vantage Medical Group Senior $0.41
Service Code NDC 0121-0646-16
Hospital Charge Code 1715916
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 0121-0646-16
Hospital Charge Code 1715916
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 61958-0802-5
Hospital Charge Code 1712539
Hospital Revenue Code 259
Min. Negotiated Rate $81.52
Max. Negotiated Rate $382.82
Rate for Payer: Adventist Health Commercial $90.08
Rate for Payer: Aetna of CA Gatekeeper $240.73
Rate for Payer: Aetna of CA Non-Gatekeeper $309.41
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $382.82
Rate for Payer: AlphaCare Medical Group Medi-Cal $247.71
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $337.78
Rate for Payer: Blue Shield of California Commercial $279.69
Rate for Payer: Blue Shield of California EPN $264.37
Rate for Payer: Cash Price $202.67
Rate for Payer: Cigna of CA HMO/PPO $292.75
Rate for Payer: Dignity Health Commercial/Exchange $382.82
Rate for Payer: Dignity Health Medi-Cal $382.82
Rate for Payer: Dignity Health Senior $382.82
Rate for Payer: EPIC Health Plan Commercial $288.24
Rate for Payer: Heritage Provider Network Commercial $278.79
Rate for Payer: Heritage Provider Network Senior $278.79
Rate for Payer: Kaiser Permanente of CA Commercial $217.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal $81.52
Rate for Payer: LLUH Dept of Risk Management WC $112.60
Rate for Payer: Multiplan Commercial $337.78
Rate for Payer: Vantage Medical Group Medi-Cal $382.82
Rate for Payer: Vantage Medical Group Senior $382.82
Service Code NDC 47335-237-83
Hospital Charge Code 1712539
Hospital Revenue Code 259
Min. Negotiated Rate $8.34
Max. Negotiated Rate $34.56
Rate for Payer: Adventist Health Commercial $9.22
Rate for Payer: Aetna of CA Non-Gatekeeper $31.66
Rate for Payer: Cash Price $20.74
Rate for Payer: EPIC Health Plan Commercial $24.88
Rate for Payer: Heritage Provider Network Commercial $31.20
Rate for Payer: Heritage Provider Network Senior $31.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal $8.34
Rate for Payer: LLUH Dept of Risk Management WC $11.52
Rate for Payer: Multiplan Commercial $34.56
Service Code NDC 61958-0802-1
Hospital Charge Code 1712539
Hospital Revenue Code 259
Min. Negotiated Rate $81.52
Max. Negotiated Rate $337.78
Rate for Payer: Adventist Health Commercial $90.08
Rate for Payer: Aetna of CA Non-Gatekeeper $309.41
Rate for Payer: Cash Price $202.67
Rate for Payer: EPIC Health Plan Commercial $243.21
Rate for Payer: Heritage Provider Network Commercial $304.91
Rate for Payer: Heritage Provider Network Senior $304.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal $81.52
Rate for Payer: LLUH Dept of Risk Management WC $112.60
Rate for Payer: Multiplan Commercial $337.78
Service Code NDC 47335-237-83
Hospital Charge Code 1712539
Hospital Revenue Code 259
Min. Negotiated Rate $8.34
Max. Negotiated Rate $39.17
Rate for Payer: Adventist Health Commercial $9.22
Rate for Payer: Aetna of CA Gatekeeper $24.63
Rate for Payer: Aetna of CA Non-Gatekeeper $31.66
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $39.17
Rate for Payer: AlphaCare Medical Group Medi-Cal $25.34
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $34.56
Rate for Payer: Blue Shield of California Commercial $28.62
Rate for Payer: Blue Shield of California EPN $27.05
Rate for Payer: Cash Price $20.74
Rate for Payer: Cigna of CA HMO/PPO $29.95
Rate for Payer: Dignity Health Commercial/Exchange $39.17
Rate for Payer: Dignity Health Medi-Cal $39.17
Rate for Payer: Dignity Health Senior $39.17
Rate for Payer: EPIC Health Plan Commercial $29.49
Rate for Payer: Heritage Provider Network Commercial $28.52
Rate for Payer: Heritage Provider Network Senior $28.52
Rate for Payer: Kaiser Permanente of CA Commercial $22.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal $8.34
Rate for Payer: LLUH Dept of Risk Management WC $11.52
Rate for Payer: Multiplan Commercial $34.56
Rate for Payer: Vantage Medical Group Medi-Cal $39.17
Rate for Payer: Vantage Medical Group Senior $39.17