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Service Code NDC 0054053222
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.30
Max. Negotiated Rate $1.41
Rate for Payer: Adventist Health Commercial $0.33
Rate for Payer: Aetna of CA Non-Gatekeeper $1.03
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $1.41
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.91
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $1.25
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.83
Rate for Payer: Blue Shield of California Commercial $1.01
Rate for Payer: Blue Shield of California EPN $0.81
Rate for Payer: Cash Price $0.75
Rate for Payer: Cigna of CA HMO/PPO $1.08
Rate for Payer: Dignity Health Commercial/Exchange $1.41
Rate for Payer: Dignity Health Medi-Cal $1.41
Rate for Payer: Dignity Health Medicare Advantage $1.41
Rate for Payer: EPIC Health Plan Commercial $1.06
Rate for Payer: Heritage Provider Network Commercial $1.03
Rate for Payer: Heritage Provider Network Senior $1.03
Rate for Payer: Kaiser Foundation Hospitals Commercial $0.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.30
Rate for Payer: LLUH Dept of Risk Management WC $0.42
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $1.16
Rate for Payer: Multiplan Commercial $1.25
Rate for Payer: TriValley Medical Group Commercial $0.66
Rate for Payer: TriValley Medical Group Senior $0.66
Rate for Payer: United Healthcare All Other HMO/non HMO $0.83
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.83
Rate for Payer: Vantage Medical Group Commercial/Exchange $1.41
Rate for Payer: Vantage Medical Group Medi-Cal $1.41
Rate for Payer: Vantage Medical Group Senior $1.41
Service Code ICD DT10B6Z
Hospital Charge Code 5548
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DT10BB1
Hospital Charge Code 5549
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DT11B6Z
Hospital Charge Code 5550
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DT11BB1
Hospital Charge Code 5551
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DT12B6Z
Hospital Charge Code 5552
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DT12BB1
Hospital Charge Code 5553
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DT13B6Z
Hospital Charge Code 5554
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DT13BB1
Hospital Charge Code 5555
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DU10B6Z
Hospital Charge Code 5556
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DU10BB1
Hospital Charge Code 5557
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DU11B6Z
Hospital Charge Code 5558
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DU11BB1
Hospital Charge Code 5559
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DU12B6Z
Hospital Charge Code 5560
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code ICD DU12BB1
Hospital Charge Code 5561
Min. Negotiated Rate $9,120.00
Max. Negotiated Rate $9,120.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $9,120.00
Service Code NDC 5199174690
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: Aetna of CA Non-Gatekeeper $0.23
Rate for Payer: Cash Price $0.16
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 Foundation Hospitals 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 6800159406
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.42
Rate for Payer: Adventist Health Commercial $0.11
Rate for Payer: Aetna of CA Non-Gatekeeper $0.36
Rate for Payer: Cash Price $0.25
Rate for Payer: EPIC Health Plan Commercial $0.30
Rate for Payer: Heritage Provider Network Commercial $0.38
Rate for Payer: Heritage Provider Network Senior $0.38
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.42
Service Code NDC 6800159406
Hospital Charge Code 901700029
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 Non-Gatekeeper $0.35
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.48
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.31
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.42
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.28
Rate for Payer: Blue Shield of California Commercial $0.34
Rate for Payer: Blue Shield of California EPN $0.27
Rate for Payer: Cash Price $0.25
Rate for Payer: Cigna of CA HMO/PPO $0.36
Rate for Payer: Dignity Health Commercial/Exchange $0.48
Rate for Payer: Dignity Health Medi-Cal $0.48
Rate for Payer: Dignity Health Medicare Advantage $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 Foundation Hospitals Commercial $0.27
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.39
Rate for Payer: Multiplan Commercial $0.42
Rate for Payer: TriValley Medical Group Commercial $0.22
Rate for Payer: TriValley Medical Group Senior $0.22
Rate for Payer: United Healthcare All Other HMO/non HMO $0.28
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.28
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.48
Rate for Payer: Vantage Medical Group Medi-Cal $0.48
Rate for Payer: Vantage Medical Group Senior $0.48
Service Code NDC 5199174690
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.31
Rate for Payer: Aetna of CA Non-Gatekeeper $0.22
Rate for Payer: Adventist Health Commercial $0.07
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: Anthem Blue Cross of CA HMO/PPO $0.18
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 $0.16
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 Medicare Advantage $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 Foundation Hospitals Commercial $0.17
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Molina Healthcare of CA Medi-Cal/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 6800159504
Hospital Charge Code 901700029
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 $0.37
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 Foundation Hospitals 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 2724109803
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 Non-Gatekeeper $0.22
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: Anthem Blue Cross of CA HMO/PPO $0.18
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 $0.16
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 Medicare Advantage $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 Foundation Hospitals Commercial $0.17
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Molina Healthcare of CA Medi-Cal/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 2724109803
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: Aetna of CA Non-Gatekeeper $0.23
Rate for Payer: Cash Price $0.16
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 Foundation Hospitals 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 6800159505
Hospital Charge Code 901700029
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 Non-Gatekeeper $0.35
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.48
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.31
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.42
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.28
Rate for Payer: Blue Shield of California Commercial $0.34
Rate for Payer: Blue Shield of California EPN $0.27
Rate for Payer: Cash Price $0.25
Rate for Payer: Cigna of CA HMO/PPO $0.36
Rate for Payer: Dignity Health Commercial/Exchange $0.48
Rate for Payer: Dignity Health Medi-Cal $0.48
Rate for Payer: Dignity Health Medicare Advantage $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 Foundation Hospitals Commercial $0.27
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.39
Rate for Payer: Multiplan Commercial $0.42
Rate for Payer: TriValley Medical Group Commercial $0.22
Rate for Payer: TriValley Medical Group Senior $0.22
Rate for Payer: United Healthcare All Other HMO/non HMO $0.28
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.28
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.48
Rate for Payer: Vantage Medical Group Medi-Cal $0.48
Rate for Payer: Vantage Medical Group Senior $0.48
Service Code NDC 6800159505
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.42
Rate for Payer: Adventist Health Commercial $0.11
Rate for Payer: Aetna of CA Non-Gatekeeper $0.36
Rate for Payer: Cash Price $0.25
Rate for Payer: EPIC Health Plan Commercial $0.30
Rate for Payer: Heritage Provider Network Commercial $0.38
Rate for Payer: Heritage Provider Network Senior $0.38
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Multiplan Commercial $0.42
Service Code NDC 6800159504
Hospital Charge Code 901700029
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 Non-Gatekeeper $0.35
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.48
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.31
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.43
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.29
Rate for Payer: Blue Shield of California Commercial $0.35
Rate for Payer: Blue Shield of California EPN $0.28
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 Medicare Advantage $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 Foundation Hospitals Commercial $0.27
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.14
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare $0.40
Rate for Payer: Multiplan Commercial $0.43
Rate for Payer: TriValley Medical Group Commercial $0.23
Rate for Payer: TriValley Medical Group Senior $0.23
Rate for Payer: United Healthcare All Other HMO/non HMO $0.29
Rate for Payer: United Healthcare Navigate/Select/Select+ $0.29
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.48
Rate for Payer: Vantage Medical Group Medi-Cal $0.48
Rate for Payer: Vantage Medical Group Senior $0.48