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Service Code NDC 31722-562-24
Hospital Charge Code NDG24439
Hospital Revenue Code 259
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.54
Rate for Payer: Blue Shield of California Commercial $0.45
Rate for Payer: Blue Shield of California EPN $0.32
Rate for Payer: Cash Price $0.28
Rate for Payer: Cigna of CA HMO $0.44
Rate for Payer: Cigna of CA PPO $0.44
Rate for Payer: EPIC Health Plan Commercial $0.25
Rate for Payer: Galaxy Health WC $0.54
Rate for Payer: Global Benefits Group Commercial $0.38
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.24
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.50
Rate for Payer: Networks By Design Commercial $0.41
Rate for Payer: Prime Health Services Commercial $0.54
Service Code NDC 31722-562-24
Hospital Charge Code NDG24439
Hospital Revenue Code 259
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.54
Rate for Payer: Aetna of CA HMO/PPO $0.41
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 $0.35
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.38
Rate for Payer: BCBS Transplant Transplant $0.38
Rate for Payer: Blue Shield of California Commercial $0.46
Rate for Payer: Blue Shield of California EPN $0.37
Rate for Payer: Cash Price $0.28
Rate for Payer: Cigna of CA HMO $0.44
Rate for Payer: Cigna of CA PPO $0.44
Rate for Payer: Dignity Health Commercial/Exchange $0.54
Rate for Payer: Dignity Health Media $0.54
Rate for Payer: Dignity Health Medi-Cal $0.54
Rate for Payer: EPIC Health Plan Commercial $0.25
Rate for Payer: EPIC Health Plan Transplant $0.25
Rate for Payer: Galaxy Health WC $0.54
Rate for Payer: Global Benefits Group Commercial $0.38
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $0.47
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.24
Rate for Payer: LLUH Dept of Risk Management WC $0.15
Rate for Payer: Multiplan Commercial $0.50
Rate for Payer: Networks By Design Commercial $0.41
Rate for Payer: Prime Health Services Commercial $0.54
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $0.38
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.38
Rate for Payer: TriValley Medical Group Commercial/Senior $0.38
Rate for Payer: United Healthcare All Other Commercial $0.32
Rate for Payer: United Healthcare All Other HMO $0.32
Rate for Payer: United Healthcare HMO Rider $0.32
Rate for Payer: United Healthcare Select/Navigate/Core $0.32
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.54
Rate for Payer: Vantage Medical Group Medi-Cal $0.54
Rate for Payer: Vantage Medical Group Senior $0.54
Service Code NDC 68084-021-11
Hospital Charge Code 1710876
Hospital Revenue Code 259
Min. Negotiated Rate $2.54
Max. Negotiated Rate $9.00
Rate for Payer: Aetna of CA HMO/PPO $6.95
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $9.00
Rate for Payer: AlphaCare Medical Group Medi-Cal $5.82
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $5.82
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $6.31
Rate for Payer: BCBS Transplant Transplant $6.35
Rate for Payer: Blue Shield of California Commercial $7.80
Rate for Payer: Blue Shield of California EPN $6.18
Rate for Payer: Cash Price $4.77
Rate for Payer: Cigna of CA HMO $7.41
Rate for Payer: Cigna of CA PPO $7.41
Rate for Payer: Dignity Health Commercial/Exchange $9.00
Rate for Payer: Dignity Health Media $9.00
Rate for Payer: Dignity Health Medi-Cal $9.00
Rate for Payer: EPIC Health Plan Commercial $4.24
Rate for Payer: EPIC Health Plan Transplant $4.24
Rate for Payer: Galaxy Health WC $9.00
Rate for Payer: Global Benefits Group Commercial $6.35
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $7.94
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $7.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal $4.03
Rate for Payer: LLUH Dept of Risk Management WC $2.54
Rate for Payer: Multiplan Commercial $8.47
Rate for Payer: Networks By Design Commercial $6.88
Rate for Payer: Prime Health Services Commercial $9.00
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $6.35
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $6.35
Rate for Payer: TriValley Medical Group Commercial/Senior $6.35
Rate for Payer: United Healthcare All Other Commercial $5.30
Rate for Payer: United Healthcare All Other HMO $5.30
Rate for Payer: United Healthcare HMO Rider $5.30
Rate for Payer: United Healthcare Select/Navigate/Core $5.30
Rate for Payer: Vantage Medical Group Commercial/Exchange $9.00
Rate for Payer: Vantage Medical Group Medi-Cal $9.00
Rate for Payer: Vantage Medical Group Senior $9.00
Service Code NDC 68084-021-11
Hospital Charge Code 1710876
Hospital Revenue Code 259
Min. Negotiated Rate $2.54
Max. Negotiated Rate $9.00
Rate for Payer: Blue Shield of California Commercial $7.54
Rate for Payer: Blue Shield of California EPN $5.42
Rate for Payer: Cash Price $4.77
Rate for Payer: Cigna of CA HMO $7.41
Rate for Payer: Cigna of CA PPO $7.41
Rate for Payer: EPIC Health Plan Commercial $4.24
Rate for Payer: Galaxy Health WC $9.00
Rate for Payer: Global Benefits Group Commercial $6.35
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $7.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal $4.03
Rate for Payer: LLUH Dept of Risk Management WC $2.54
Rate for Payer: Multiplan Commercial $8.47
Rate for Payer: Networks By Design Commercial $6.88
Rate for Payer: Prime Health Services Commercial $9.00
Service Code NDC 31722-557-60
Hospital Charge Code 1710876
Hospital Revenue Code 259
Min. Negotiated Rate $0.72
Max. Negotiated Rate $2.55
Rate for Payer: Blue Shield of California Commercial $2.14
Rate for Payer: Blue Shield of California EPN $1.54
Rate for Payer: Cash Price $1.35
Rate for Payer: Cigna of CA HMO $2.10
Rate for Payer: Cigna of CA PPO $2.10
Rate for Payer: EPIC Health Plan Commercial $1.20
Rate for Payer: Galaxy Health WC $2.55
Rate for Payer: Global Benefits Group Commercial $1.80
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.14
Rate for Payer: LLUH Dept of Risk Management WC $0.72
Rate for Payer: Multiplan Commercial $2.40
Rate for Payer: Networks By Design Commercial $1.95
Rate for Payer: Prime Health Services Commercial $2.55
Service Code NDC 31722-557-60
Hospital Charge Code 1710876
Hospital Revenue Code 259
Min. Negotiated Rate $0.72
Max. Negotiated Rate $2.55
Rate for Payer: Galaxy Health WC $2.55
Rate for Payer: Aetna of CA HMO/PPO $1.97
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 $1.65
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $1.79
Rate for Payer: BCBS Transplant Transplant $1.80
Rate for Payer: Blue Shield of California Commercial $2.21
Rate for Payer: Blue Shield of California EPN $1.75
Rate for Payer: Cash Price $1.35
Rate for Payer: Cigna of CA HMO $2.10
Rate for Payer: Cigna of CA PPO $2.10
Rate for Payer: Dignity Health Commercial/Exchange $2.55
Rate for Payer: Dignity Health Media $2.55
Rate for Payer: Dignity Health Medi-Cal $2.55
Rate for Payer: EPIC Health Plan Commercial $1.20
Rate for Payer: EPIC Health Plan Transplant $1.20
Rate for Payer: Global Benefits Group Commercial $1.80
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $2.25
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.14
Rate for Payer: LLUH Dept of Risk Management WC $0.72
Rate for Payer: Multiplan Commercial $2.40
Rate for Payer: Networks By Design Commercial $1.95
Rate for Payer: Prime Health Services Commercial $2.55
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $1.80
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $1.80
Rate for Payer: TriValley Medical Group Commercial/Senior $1.80
Rate for Payer: United Healthcare All Other Commercial $1.50
Rate for Payer: United Healthcare All Other HMO $1.50
Rate for Payer: United Healthcare HMO Rider $1.50
Rate for Payer: United Healthcare Select/Navigate/Core $1.50
Rate for Payer: Vantage Medical Group Commercial/Exchange $2.55
Rate for Payer: Vantage Medical Group Medi-Cal $2.55
Rate for Payer: Vantage Medical Group Senior $2.55
Service Code NDC 49702-231-13
Hospital Charge Code ERX207101
Hospital Revenue Code 259
Min. Negotiated Rate $33.96
Max. Negotiated Rate $120.28
Rate for Payer: Aetna of CA HMO/PPO $92.81
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $120.28
Rate for Payer: AlphaCare Medical Group Medi-Cal $77.82
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $77.82
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $84.31
Rate for Payer: BCBS Transplant Transplant $84.90
Rate for Payer: Blue Shield of California Commercial $104.29
Rate for Payer: Blue Shield of California EPN $82.64
Rate for Payer: Cash Price $63.68
Rate for Payer: Cigna of CA HMO $99.05
Rate for Payer: Cigna of CA PPO $99.05
Rate for Payer: Dignity Health Commercial/Exchange $120.28
Rate for Payer: Dignity Health Media $120.28
Rate for Payer: Dignity Health Medi-Cal $120.28
Rate for Payer: EPIC Health Plan Commercial $56.60
Rate for Payer: EPIC Health Plan Transplant $56.60
Rate for Payer: Galaxy Health WC $120.28
Rate for Payer: Global Benefits Group Commercial $84.90
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $106.12
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $94.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal $53.91
Rate for Payer: LLUH Dept of Risk Management WC $33.96
Rate for Payer: Multiplan Commercial $113.20
Rate for Payer: Networks By Design Commercial $91.98
Rate for Payer: Prime Health Services Commercial $120.28
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $84.90
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $84.90
Rate for Payer: TriValley Medical Group Commercial/Senior $84.90
Rate for Payer: United Healthcare All Other Commercial $70.75
Rate for Payer: United Healthcare All Other HMO $70.75
Rate for Payer: United Healthcare HMO Rider $70.75
Rate for Payer: United Healthcare Select/Navigate/Core $70.75
Rate for Payer: Vantage Medical Group Commercial/Exchange $120.28
Rate for Payer: Vantage Medical Group Medi-Cal $120.28
Rate for Payer: Vantage Medical Group Senior $120.28
Service Code NDC 49702-231-13
Hospital Charge Code ERX207101
Hospital Revenue Code 259
Min. Negotiated Rate $33.96
Max. Negotiated Rate $120.28
Rate for Payer: Blue Shield of California Commercial $100.75
Rate for Payer: Blue Shield of California EPN $72.45
Rate for Payer: Cash Price $63.68
Rate for Payer: Cigna of CA HMO $99.05
Rate for Payer: Cigna of CA PPO $99.05
Rate for Payer: EPIC Health Plan Commercial $56.60
Rate for Payer: Galaxy Health WC $120.28
Rate for Payer: Global Benefits Group Commercial $84.90
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $94.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal $53.91
Rate for Payer: LLUH Dept of Risk Management WC $33.96
Rate for Payer: Multiplan Commercial $113.20
Rate for Payer: Networks By Design Commercial $91.98
Rate for Payer: Prime Health Services Commercial $120.28
Service Code NDC 69097-362-02
Hospital Charge Code 1711932
Hospital Revenue Code 259
Min. Negotiated Rate $0.96
Max. Negotiated Rate $3.40
Rate for Payer: Blue Shield of California Commercial $2.85
Rate for Payer: Blue Shield of California EPN $2.05
Rate for Payer: Cash Price $1.80
Rate for Payer: Cigna of CA HMO $2.80
Rate for Payer: Cigna of CA PPO $2.80
Rate for Payer: EPIC Health Plan Commercial $1.60
Rate for Payer: Galaxy Health WC $3.40
Rate for Payer: Global Benefits Group Commercial $2.40
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.52
Rate for Payer: LLUH Dept of Risk Management WC $0.96
Rate for Payer: Multiplan Commercial $3.20
Rate for Payer: Networks By Design Commercial $2.60
Rate for Payer: Prime Health Services Commercial $3.40
Service Code NDC 69097-362-02
Hospital Charge Code 1711932
Hospital Revenue Code 259
Min. Negotiated Rate $0.96
Max. Negotiated Rate $3.40
Rate for Payer: Galaxy Health WC $3.40
Rate for Payer: Aetna of CA HMO/PPO $2.62
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $3.40
Rate for Payer: AlphaCare Medical Group Medi-Cal $2.20
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $2.20
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $2.38
Rate for Payer: BCBS Transplant Transplant $2.40
Rate for Payer: Blue Shield of California Commercial $2.95
Rate for Payer: Blue Shield of California EPN $2.34
Rate for Payer: Cash Price $1.80
Rate for Payer: Cigna of CA HMO $2.80
Rate for Payer: Cigna of CA PPO $2.80
Rate for Payer: Dignity Health Commercial/Exchange $3.40
Rate for Payer: Dignity Health Media $3.40
Rate for Payer: Dignity Health Medi-Cal $3.40
Rate for Payer: EPIC Health Plan Commercial $1.60
Rate for Payer: EPIC Health Plan Transplant $1.60
Rate for Payer: Global Benefits Group Commercial $2.40
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $3.00
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.52
Rate for Payer: LLUH Dept of Risk Management WC $0.96
Rate for Payer: Multiplan Commercial $3.20
Rate for Payer: Networks By Design Commercial $2.60
Rate for Payer: Prime Health Services Commercial $3.40
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $2.40
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $2.40
Rate for Payer: TriValley Medical Group Commercial/Senior $2.40
Rate for Payer: United Healthcare All Other Commercial $2.00
Rate for Payer: United Healthcare All Other HMO $2.00
Rate for Payer: United Healthcare HMO Rider $2.00
Rate for Payer: United Healthcare Select/Navigate/Core $2.00
Rate for Payer: Vantage Medical Group Commercial/Exchange $3.40
Rate for Payer: Vantage Medical Group Medi-Cal $3.40
Rate for Payer: Vantage Medical Group Senior $3.40
Service Code CPT J0129
Hospital Charge Code 1720952
Hospital Revenue Code 636
Min. Negotiated Rate $397.41
Max. Negotiated Rate $1,407.50
Rate for Payer: Blue Shield of California Commercial $1,178.99
Rate for Payer: Blue Shield of California EPN $847.81
Rate for Payer: Cash Price $745.15
Rate for Payer: Cigna of CA HMO $1,159.12
Rate for Payer: Cigna of CA PPO $1,159.12
Rate for Payer: EPIC Health Plan Commercial $662.35
Rate for Payer: EPIC Health Plan Transplant $662.35
Rate for Payer: Galaxy Health WC $1,407.50
Rate for Payer: Global Benefits Group Commercial $993.53
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1,104.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal $630.89
Rate for Payer: LLUH Dept of Risk Management WC $397.41
Rate for Payer: Multiplan Commercial $1,324.70
Rate for Payer: Networks By Design Commercial $827.94
Rate for Payer: Prime Health Services Commercial $1,407.50
Service Code CPT J0129
Hospital Charge Code 1720952
Hospital Revenue Code 636
Min. Negotiated Rate $40.06
Max. Negotiated Rate $1,407.50
Rate for Payer: Aetna of CA HMO/PPO $85.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $53.95
Rate for Payer: AlphaCare Medical Group Medi-Cal $47.48
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $47.48
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $40.06
Rate for Payer: BCBS Transplant Transplant $993.53
Rate for Payer: Blue Shield of California Commercial $1,220.38
Rate for Payer: Blue Shield of California EPN $56.43
Rate for Payer: Cash Price $745.15
Rate for Payer: Cash Price $745.15
Rate for Payer: Cigna of CA HMO $1,159.12
Rate for Payer: Cigna of CA PPO $1,159.12
Rate for Payer: Dignity Health Commercial/Exchange $64.74
Rate for Payer: Dignity Health Media $43.16
Rate for Payer: Dignity Health Medi-Cal $47.48
Rate for Payer: EPIC Health Plan Commercial $58.27
Rate for Payer: EPIC Health Plan Medicare/Senior $43.16
Rate for Payer: EPIC Health Plan Transplant $43.16
Rate for Payer: Galaxy Health WC $1,407.50
Rate for Payer: Global Benefits Group Commercial $993.53
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $1,241.91
Rate for Payer: Heritage Provider Network Commercial $70.79
Rate for Payer: Heritage Provider Network Transplant $70.79
Rate for Payer: IEHP Medi-Cal $69.92
Rate for Payer: IEHP Medi-Cal Transplant $69.92
Rate for Payer: IEHP Medicare Advantage $43.16
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1,104.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal $90.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $43.16
Rate for Payer: LLUH Dept of Risk Management WC $397.41
Rate for Payer: Molina Healthcare of CA Medi-Cal $54.39
Rate for Payer: Molina Healthcare of CA Medicare $57.84
Rate for Payer: Multiplan Commercial $1,324.70
Rate for Payer: Networks By Design Commercial $827.94
Rate for Payer: Prime Health Services Commercial $1,407.50
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $993.53
Rate for Payer: TriValley Medical Group Commercial/Senior $993.53
Rate for Payer: United Healthcare All Other Commercial $827.94
Rate for Payer: United Healthcare All Other HMO $827.94
Rate for Payer: United Healthcare HMO Rider $827.94
Rate for Payer: United Healthcare Select/Navigate/Core $827.94
Rate for Payer: Vantage Medical Group Commercial/Exchange $64.74
Rate for Payer: Vantage Medical Group Medi-Cal $47.48
Rate for Payer: Vantage Medical Group Senior $43.16
Service Code APR-DRG 2511
Min. Negotiated Rate $5,626.74
Max. Negotiated Rate $7,335.03
Rate for Payer: IEHP Medi-Cal $5,626.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal $7,335.03
Service Code APR-DRG 2512
Min. Negotiated Rate $7,267.42
Max. Negotiated Rate $9,473.82
Rate for Payer: IEHP Medi-Cal $7,267.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal $9,473.82
Service Code APR-DRG 2513
Min. Negotiated Rate $9,593.76
Max. Negotiated Rate $12,506.45
Rate for Payer: IEHP Medi-Cal $9,593.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal $12,506.45
Service Code APR-DRG 2514
Min. Negotiated Rate $16,213.61
Max. Negotiated Rate $21,136.09
Rate for Payer: IEHP Medi-Cal $16,213.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal $21,136.09
Service Code NDC 0002-4815-54
Hospital Charge Code ERX219901
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Aetna of CA HMO/PPO $204.27
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $264.72
Rate for Payer: AlphaCare Medical Group Medi-Cal $171.29
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $171.29
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $185.56
Rate for Payer: BCBS Transplant Transplant $186.86
Rate for Payer: Blue Shield of California Commercial $229.53
Rate for Payer: Blue Shield of California EPN $181.88
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: Dignity Health Commercial/Exchange $264.72
Rate for Payer: Dignity Health Media $264.72
Rate for Payer: Dignity Health Medi-Cal $264.72
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: EPIC Health Plan Transplant $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $233.58
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $186.86
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $186.86
Rate for Payer: TriValley Medical Group Commercial/Senior $186.86
Rate for Payer: United Healthcare All Other Commercial $155.72
Rate for Payer: United Healthcare All Other HMO $155.72
Rate for Payer: United Healthcare HMO Rider $155.72
Rate for Payer: United Healthcare Select/Navigate/Core $155.72
Rate for Payer: Vantage Medical Group Commercial/Exchange $264.72
Rate for Payer: Vantage Medical Group Medi-Cal $264.72
Rate for Payer: Vantage Medical Group Senior $264.72
Service Code NDC 0002-4815-54
Hospital Charge Code ERX219901
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Blue Shield of California Commercial $221.75
Rate for Payer: Blue Shield of California EPN $159.46
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Service Code NDC 0002-5337-54
Hospital Charge Code ERX219900
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Aetna of CA HMO/PPO $204.27
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $264.72
Rate for Payer: AlphaCare Medical Group Medi-Cal $171.29
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $171.29
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $185.56
Rate for Payer: BCBS Transplant Transplant $186.86
Rate for Payer: Blue Shield of California Commercial $229.53
Rate for Payer: Blue Shield of California EPN $181.88
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: Dignity Health Commercial/Exchange $264.72
Rate for Payer: Dignity Health Media $264.72
Rate for Payer: Dignity Health Medi-Cal $264.72
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: EPIC Health Plan Transplant $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $233.58
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $186.86
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $186.86
Rate for Payer: TriValley Medical Group Commercial/Senior $186.86
Rate for Payer: United Healthcare All Other Commercial $155.72
Rate for Payer: United Healthcare All Other HMO $155.72
Rate for Payer: United Healthcare HMO Rider $155.72
Rate for Payer: United Healthcare Select/Navigate/Core $155.72
Rate for Payer: Vantage Medical Group Commercial/Exchange $264.72
Rate for Payer: Vantage Medical Group Medi-Cal $264.72
Rate for Payer: Vantage Medical Group Senior $264.72
Service Code NDC 0002-5337-54
Hospital Charge Code ERX219900
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Blue Shield of California Commercial $221.75
Rate for Payer: Blue Shield of California EPN $159.46
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Service Code NDC 0002-6216-54
Hospital Charge Code ERX219899
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Blue Shield of California Commercial $221.75
Rate for Payer: Blue Shield of California EPN $159.46
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Service Code NDC 0002-6216-54
Hospital Charge Code ERX219899
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Aetna of CA HMO/PPO $204.27
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $264.72
Rate for Payer: AlphaCare Medical Group Medi-Cal $171.29
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $171.29
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $185.56
Rate for Payer: BCBS Transplant Transplant $186.86
Rate for Payer: Blue Shield of California Commercial $229.53
Rate for Payer: Blue Shield of California EPN $181.88
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: Dignity Health Commercial/Exchange $264.72
Rate for Payer: Dignity Health Media $264.72
Rate for Payer: Dignity Health Medi-Cal $264.72
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: EPIC Health Plan Transplant $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $233.58
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $186.86
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $186.86
Rate for Payer: TriValley Medical Group Commercial/Senior $186.86
Rate for Payer: United Healthcare All Other Commercial $155.72
Rate for Payer: United Healthcare All Other HMO $155.72
Rate for Payer: United Healthcare HMO Rider $155.72
Rate for Payer: United Healthcare Select/Navigate/Core $155.72
Rate for Payer: Vantage Medical Group Commercial/Exchange $264.72
Rate for Payer: Vantage Medical Group Medi-Cal $264.72
Rate for Payer: Vantage Medical Group Senior $264.72
Service Code NDC 0002-4483-54
Hospital Charge Code ERX219902
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Blue Shield of California Commercial $221.75
Rate for Payer: Blue Shield of California EPN $159.46
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Service Code NDC 0002-4483-54
Hospital Charge Code ERX219902
Hospital Revenue Code 259
Min. Negotiated Rate $74.75
Max. Negotiated Rate $264.72
Rate for Payer: Aetna of CA HMO/PPO $204.27
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $264.72
Rate for Payer: AlphaCare Medical Group Medi-Cal $171.29
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $171.29
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $185.56
Rate for Payer: BCBS Transplant Transplant $186.86
Rate for Payer: Blue Shield of California Commercial $229.53
Rate for Payer: Blue Shield of California EPN $181.88
Rate for Payer: Cash Price $140.15
Rate for Payer: Cigna of CA HMO $218.01
Rate for Payer: Cigna of CA PPO $218.01
Rate for Payer: Dignity Health Commercial/Exchange $264.72
Rate for Payer: Dignity Health Media $264.72
Rate for Payer: Dignity Health Medi-Cal $264.72
Rate for Payer: EPIC Health Plan Commercial $124.58
Rate for Payer: EPIC Health Plan Transplant $124.58
Rate for Payer: Galaxy Health WC $264.72
Rate for Payer: Global Benefits Group Commercial $186.86
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $233.58
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $207.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal $118.66
Rate for Payer: LLUH Dept of Risk Management WC $74.75
Rate for Payer: Multiplan Commercial $249.15
Rate for Payer: Networks By Design Commercial $202.44
Rate for Payer: Prime Health Services Commercial $264.72
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $186.86
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $186.86
Rate for Payer: TriValley Medical Group Commercial/Senior $186.86
Rate for Payer: United Healthcare All Other Commercial $155.72
Rate for Payer: United Healthcare All Other HMO $155.72
Rate for Payer: United Healthcare HMO Rider $155.72
Rate for Payer: United Healthcare Select/Navigate/Core $155.72
Rate for Payer: Vantage Medical Group Commercial/Exchange $264.72
Rate for Payer: Vantage Medical Group Medi-Cal $264.72
Rate for Payer: Vantage Medical Group Senior $264.72
Service Code NDC 57894-150-12
Hospital Charge Code 1712538
Hospital Revenue Code 259
Min. Negotiated Rate $26.13
Max. Negotiated Rate $92.54
Rate for Payer: Aetna of CA HMO/PPO $71.41
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $92.54
Rate for Payer: AlphaCare Medical Group Medi-Cal $59.88
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $59.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $64.86
Rate for Payer: BCBS Transplant Transplant $65.32
Rate for Payer: Blue Shield of California Commercial $80.24
Rate for Payer: Blue Shield of California EPN $63.58
Rate for Payer: Cash Price $48.99
Rate for Payer: Cigna of CA HMO $76.21
Rate for Payer: Cigna of CA PPO $76.21
Rate for Payer: Dignity Health Commercial/Exchange $92.54
Rate for Payer: Dignity Health Media $92.54
Rate for Payer: Dignity Health Medi-Cal $92.54
Rate for Payer: EPIC Health Plan Commercial $43.55
Rate for Payer: EPIC Health Plan Transplant $43.55
Rate for Payer: Galaxy Health WC $92.54
Rate for Payer: Global Benefits Group Commercial $65.32
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $81.65
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $72.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal $41.48
Rate for Payer: LLUH Dept of Risk Management WC $26.13
Rate for Payer: Multiplan Commercial $87.10
Rate for Payer: Networks By Design Commercial $70.77
Rate for Payer: Prime Health Services Commercial $92.54
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $65.32
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $65.32
Rate for Payer: TriValley Medical Group Commercial/Senior $65.32
Rate for Payer: United Healthcare All Other Commercial $54.44
Rate for Payer: United Healthcare All Other HMO $54.44
Rate for Payer: United Healthcare HMO Rider $54.44
Rate for Payer: United Healthcare Select/Navigate/Core $54.44
Rate for Payer: Vantage Medical Group Commercial/Exchange $92.54
Rate for Payer: Vantage Medical Group Medi-Cal $92.54
Rate for Payer: Vantage Medical Group Senior $92.54