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All Charges

Charge Type Setting Price  
Service Code NDC 9994080361
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.37
Rate for Payer: Adventist Health Commercial $0.09
Rate for Payer: Aetna of CA HMO/PPO $0.29
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.37
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.24
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.33
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.28
Rate for Payer: Cash Price $0.20
Rate for Payer: Cigna of CA HMO $0.31
Rate for Payer: Cigna of CA PPO $0.31
Rate for Payer: Dignity Health Commercial/Exchange $0.37
Rate for Payer: Dignity Health Medi-Cal $0.37
Rate for Payer: Dignity Health Medicare Advantage $0.37
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant $0.31
Rate for Payer: EPIC Health Plan Commercial $0.18
Rate for Payer: EPIC Health Plan Senior $0.18
Rate for Payer: Galaxy Health WC $0.37
Rate for Payer: Global Benefits Group Commercial $0.26
Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded $0.28
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $0.16
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.11
Rate for Payer: Molina Healthcare of CA Medi-Cal $0.31
Rate for Payer: Molina Healthcare of CA Medicare $0.31
Rate for Payer: Multiplan Commercial $0.35
Rate for Payer: Networks By Design Commercial $0.29
Rate for Payer: Prime Health Services Commercial $0.37
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.26
Rate for Payer: TriValley Medical Group Commercial/Senior $0.26
Rate for Payer: United Healthcare All Other Commercial $0.22
Rate for Payer: United Healthcare All Other HMO $0.22
Rate for Payer: United Healthcare HMO Rider $0.22
Rate for Payer: United Healthcare Select/Navigate/Core $0.22
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.37
Rate for Payer: Vantage Medical Group Medi-Cal $0.37
Rate for Payer: Vantage Medical Group Senior $0.37
Service Code NDC 9994080361
Hospital Charge Code 901700029
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.37
Rate for Payer: Adventist Health Commercial $0.09
Rate for Payer: Blue Shield of California Commercial $0.22
Rate for Payer: Blue Shield of California Commercial $0.34
Rate for Payer: Cash Price $0.20
Rate for Payer: Cigna of CA HMO $0.31
Rate for Payer: Cigna of CA PPO $0.31
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant $0.31
Rate for Payer: EPIC Health Plan Commercial $0.18
Rate for Payer: EPIC Health Plan Senior $0.18
Rate for Payer: Galaxy Health WC $0.37
Rate for Payer: Global Benefits Group Commercial $0.26
Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded $0.28
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $0.26
Rate for Payer: LLUH Dept of Risk Management WC $0.11
Rate for Payer: Multiplan Commercial $0.35
Rate for Payer: Networks By Design Commercial $0.29
Rate for Payer: Prime Health Services Commercial $0.37