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Service Code NDC 65862-063-01
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.03
Rate for Payer: Aetna of CA HMO/PPO $0.02
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.03
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.02
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.02
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.02
Rate for Payer: Blue Distinction Transplant $0.02
Rate for Payer: Blue Shield of California Commercial $0.02
Rate for Payer: Blue Shield of California EPN $0.02
Rate for Payer: Cash Price $0.01
Rate for Payer: Cigna of CA HMO $0.02
Rate for Payer: Cigna of CA PPO $0.02
Rate for Payer: Dignity Health Commercial/Exchange $0.03
Rate for Payer: Dignity Health Media $0.03
Rate for Payer: Dignity Health Medi-Cal $0.03
Rate for Payer: EPIC Health Plan Commercial $0.01
Rate for Payer: EPIC Health Plan Transplant $0.01
Rate for Payer: Galaxy Health WC $0.03
Rate for Payer: Global Benefits Group Commercial $0.02
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.02
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.01
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.02
Rate for Payer: Networks By Design Commercial $0.02
Rate for Payer: Prime Health Services Commercial $0.03
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.02
Rate for Payer: TriValley Medical Group Commercial/Senior $0.02
Rate for Payer: United Healthcare All Other Commercial $0.02
Rate for Payer: United Healthcare All Other HMO $0.02
Rate for Payer: United Healthcare HMO Rider $0.02
Rate for Payer: United Healthcare Select/Navigate/Core $0.02
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.03
Rate for Payer: Vantage Medical Group Medi-Cal $0.03
Rate for Payer: Vantage Medical Group Senior $0.03
Service Code NDC 51079-801-20
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.08
Rate for Payer: Aetna of CA HMO/PPO $0.06
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.08
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.05
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.05
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.05
Rate for Payer: Blue Distinction Transplant $0.05
Rate for Payer: Blue Shield of California Commercial $0.07
Rate for Payer: Blue Shield of California EPN $0.05
Rate for Payer: Cash Price $0.04
Rate for Payer: Cigna of CA HMO $0.06
Rate for Payer: Cigna of CA PPO $0.06
Rate for Payer: Dignity Health Commercial/Exchange $0.08
Rate for Payer: Dignity Health Media $0.08
Rate for Payer: Dignity Health Medi-Cal $0.08
Rate for Payer: EPIC Health Plan Commercial $0.04
Rate for Payer: EPIC Health Plan Transplant $0.04
Rate for Payer: Galaxy Health WC $0.08
Rate for Payer: Global Benefits Group Commercial $0.05
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.07
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.07
Rate for Payer: Networks By Design Commercial $0.06
Rate for Payer: Prime Health Services Commercial $0.08
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.05
Rate for Payer: TriValley Medical Group Commercial/Senior $0.05
Rate for Payer: United Healthcare All Other Commercial $0.05
Rate for Payer: United Healthcare All Other HMO $0.05
Rate for Payer: United Healthcare HMO Rider $0.05
Rate for Payer: United Healthcare Select/Navigate/Core $0.05
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.08
Rate for Payer: Vantage Medical Group Medi-Cal $0.08
Rate for Payer: Vantage Medical Group Senior $0.08
Service Code NDC 57664-477-52
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.03
Rate for Payer: Blue Shield of California Commercial $0.03
Rate for Payer: Blue Shield of California EPN $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Cigna of CA HMO $0.03
Rate for Payer: Cigna of CA PPO $0.03
Rate for Payer: EPIC Health Plan Commercial $0.02
Rate for Payer: Galaxy Health WC $0.03
Rate for Payer: Global Benefits Group Commercial $0.02
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.03
Rate for Payer: Networks By Design Commercial $0.03
Rate for Payer: Prime Health Services Commercial $0.03
Service Code NDC 62584-266-01
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.11
Rate for Payer: Aetna of CA HMO/PPO $0.09
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.11
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.07
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.07
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.08
Rate for Payer: Blue Distinction Transplant $0.08
Rate for Payer: Blue Shield of California Commercial $0.10
Rate for Payer: Blue Shield of California EPN $0.08
Rate for Payer: Cash Price $0.06
Rate for Payer: Cigna of CA HMO $0.09
Rate for Payer: Cigna of CA PPO $0.09
Rate for Payer: Dignity Health Commercial/Exchange $0.11
Rate for Payer: Dignity Health Media $0.11
Rate for Payer: Dignity Health Medi-Cal $0.11
Rate for Payer: EPIC Health Plan Commercial $0.05
Rate for Payer: EPIC Health Plan Transplant $0.05
Rate for Payer: Galaxy Health WC $0.11
Rate for Payer: Global Benefits Group Commercial $0.08
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.10
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.10
Rate for Payer: Networks By Design Commercial $0.08
Rate for Payer: Prime Health Services Commercial $0.11
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.08
Rate for Payer: TriValley Medical Group Commercial/Senior $0.08
Rate for Payer: United Healthcare All Other Commercial $0.07
Rate for Payer: United Healthcare All Other HMO $0.07
Rate for Payer: United Healthcare HMO Rider $0.07
Rate for Payer: United Healthcare Select/Navigate/Core $0.07
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.11
Rate for Payer: Vantage Medical Group Medi-Cal $0.11
Rate for Payer: Vantage Medical Group Senior $0.11
Service Code NDC 57664-477-52
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.03
Rate for Payer: Aetna of CA HMO/PPO $0.03
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.03
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.02
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.02
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.02
Rate for Payer: Blue Distinction Transplant $0.02
Rate for Payer: Blue Shield of California Commercial $0.03
Rate for Payer: Blue Shield of California EPN $0.02
Rate for Payer: Cash Price $0.02
Rate for Payer: Cigna of CA HMO $0.03
Rate for Payer: Cigna of CA PPO $0.03
Rate for Payer: Dignity Health Commercial/Exchange $0.03
Rate for Payer: Dignity Health Media $0.03
Rate for Payer: Dignity Health Medi-Cal $0.03
Rate for Payer: EPIC Health Plan Commercial $0.02
Rate for Payer: EPIC Health Plan Transplant $0.02
Rate for Payer: Galaxy Health WC $0.03
Rate for Payer: Global Benefits Group Commercial $0.02
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.03
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.02
Rate for Payer: LLUH Dept of Risk Management WC $0.01
Rate for Payer: Multiplan Commercial $0.03
Rate for Payer: Networks By Design Commercial $0.03
Rate for Payer: Prime Health Services Commercial $0.03
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.02
Rate for Payer: TriValley Medical Group Commercial/Senior $0.02
Rate for Payer: United Healthcare All Other Commercial $0.02
Rate for Payer: United Healthcare All Other HMO $0.02
Rate for Payer: United Healthcare HMO Rider $0.02
Rate for Payer: United Healthcare Select/Navigate/Core $0.02
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.03
Rate for Payer: Vantage Medical Group Medi-Cal $0.03
Rate for Payer: Vantage Medical Group Senior $0.03
Service Code NDC 51079-801-01
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.08
Rate for Payer: Aetna of CA HMO/PPO $0.06
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.08
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.05
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.05
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.05
Rate for Payer: Blue Distinction Transplant $0.05
Rate for Payer: Blue Shield of California Commercial $0.07
Rate for Payer: Blue Shield of California EPN $0.05
Rate for Payer: Cash Price $0.04
Rate for Payer: Cigna of CA HMO $0.06
Rate for Payer: Cigna of CA PPO $0.06
Rate for Payer: Dignity Health Commercial/Exchange $0.08
Rate for Payer: Dignity Health Media $0.08
Rate for Payer: Dignity Health Medi-Cal $0.08
Rate for Payer: EPIC Health Plan Commercial $0.04
Rate for Payer: EPIC Health Plan Transplant $0.04
Rate for Payer: Galaxy Health WC $0.08
Rate for Payer: Global Benefits Group Commercial $0.05
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.07
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.07
Rate for Payer: Networks By Design Commercial $0.06
Rate for Payer: Prime Health Services Commercial $0.08
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.05
Rate for Payer: TriValley Medical Group Commercial/Senior $0.05
Rate for Payer: United Healthcare All Other Commercial $0.05
Rate for Payer: United Healthcare All Other HMO $0.05
Rate for Payer: United Healthcare HMO Rider $0.05
Rate for Payer: United Healthcare Select/Navigate/Core $0.05
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.08
Rate for Payer: Vantage Medical Group Medi-Cal $0.08
Rate for Payer: Vantage Medical Group Senior $0.08
Service Code NDC 62584-266-11
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.11
Rate for Payer: Blue Shield of California Commercial $0.09
Rate for Payer: Blue Shield of California EPN $0.07
Rate for Payer: Cash Price $0.06
Rate for Payer: Cigna of CA HMO $0.09
Rate for Payer: Cigna of CA PPO $0.09
Rate for Payer: EPIC Health Plan Commercial $0.05
Rate for Payer: Galaxy Health WC $0.11
Rate for Payer: Global Benefits Group Commercial $0.08
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.05
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: Multiplan Commercial $0.10
Rate for Payer: Networks By Design Commercial $0.08
Rate for Payer: Prime Health Services Commercial $0.11
Service Code NDC 51079-801-20
Hospital Charge Code 1710579
Hospital Revenue Code 259
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.08
Rate for Payer: Blue Shield of California Commercial $0.06
Rate for Payer: Blue Shield of California EPN $0.05
Rate for Payer: Cash Price $0.04
Rate for Payer: Cigna of CA HMO $0.06
Rate for Payer: Cigna of CA PPO $0.06
Rate for Payer: EPIC Health Plan Commercial $0.04
Rate for Payer: Galaxy Health WC $0.08
Rate for Payer: Global Benefits Group Commercial $0.05
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.02
Rate for Payer: Multiplan Commercial $0.07
Rate for Payer: Networks By Design Commercial $0.06
Rate for Payer: Prime Health Services Commercial $0.08
Service Code NDC 47781-587-17
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Blue Shield of California Commercial $0.17
Rate for Payer: Blue Shield of California EPN $0.12
Rate for Payer: Cash Price $0.11
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Service Code NDC 72266-122-01
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Blue Shield of California Commercial $0.16
Rate for Payer: Blue Shield of California EPN $0.12
Rate for Payer: Cash Price $0.10
Rate for Payer: EPIC Health Plan Commercial $0.09
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.18
Rate for Payer: Networks By Design Commercial $0.15
Rate for Payer: Prime Health Services Commercial $0.20
Service Code NDC 47781-587-20
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Blue Shield of California Commercial $0.17
Rate for Payer: Blue Shield of California EPN $0.12
Rate for Payer: Cash Price $0.11
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Service Code NDC 72611-740-01
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Blue Shield of California Commercial $0.17
Rate for Payer: Blue Shield of California EPN $0.12
Rate for Payer: Cash Price $0.11
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Service Code NDC 0409-1778-15
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.24
Rate for Payer: Blue Shield of California Commercial $0.20
Rate for Payer: Blue Shield of California EPN $0.14
Rate for Payer: Cash Price $0.13
Rate for Payer: EPIC Health Plan Commercial $0.11
Rate for Payer: Galaxy Health WC $0.24
Rate for Payer: Global Benefits Group Commercial $0.17
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Multiplan Commercial $0.22
Rate for Payer: Networks By Design Commercial $0.18
Rate for Payer: Prime Health Services Commercial $0.24
Service Code NDC 47781-587-17
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of CA HMO/PPO $0.16
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.20
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.13
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.13
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.14
Rate for Payer: Blue Distinction Transplant $0.14
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.14
Rate for Payer: Cash Price $0.11
Rate for Payer: Cigna of CA HMO $0.15
Rate for Payer: Cigna of CA PPO $0.18
Rate for Payer: Dignity Health Commercial/Exchange $0.20
Rate for Payer: Dignity Health Media $0.20
Rate for Payer: Dignity Health Medi-Cal $0.20
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: EPIC Health Plan Transplant $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.18
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.14
Rate for Payer: TriValley Medical Group Commercial/Senior $0.14
Rate for Payer: United Healthcare All Other Commercial $0.12
Rate for Payer: United Healthcare All Other HMO $0.12
Rate for Payer: United Healthcare HMO Rider $0.12
Rate for Payer: United Healthcare Select/Navigate/Core $0.12
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.20
Rate for Payer: Vantage Medical Group Medi-Cal $0.20
Rate for Payer: Vantage Medical Group Senior $0.20
Service Code NDC 0409-1778-05
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.24
Rate for Payer: Blue Shield of California Commercial $0.20
Rate for Payer: Blue Shield of California EPN $0.14
Rate for Payer: Cash Price $0.13
Rate for Payer: EPIC Health Plan Commercial $0.11
Rate for Payer: Galaxy Health WC $0.24
Rate for Payer: Global Benefits Group Commercial $0.17
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Multiplan Commercial $0.22
Rate for Payer: Networks By Design Commercial $0.18
Rate for Payer: Prime Health Services Commercial $0.24
Service Code NDC 70860-300-05
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.37
Rate for Payer: Blue Shield of California Commercial $0.31
Rate for Payer: Blue Shield of California EPN $0.22
Rate for Payer: Cash Price $0.19
Rate for Payer: EPIC Health Plan Commercial $0.17
Rate for Payer: Galaxy Health WC $0.37
Rate for Payer: Global Benefits Group Commercial $0.26
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.10
Rate for Payer: Multiplan Commercial $0.34
Rate for Payer: Networks By Design Commercial $0.28
Rate for Payer: Prime Health Services Commercial $0.37
Service Code NDC 70860-300-41
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.37
Rate for Payer: Aetna of CA HMO/PPO $0.28
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 $0.24
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.26
Rate for Payer: Blue Distinction Transplant $0.26
Rate for Payer: Blue Shield of California Commercial $0.32
Rate for Payer: Blue Shield of California EPN $0.25
Rate for Payer: Cash Price $0.19
Rate for Payer: Cigna of CA HMO $0.28
Rate for Payer: Cigna of CA PPO $0.32
Rate for Payer: Dignity Health Commercial/Exchange $0.37
Rate for Payer: Dignity Health Media $0.37
Rate for Payer: Dignity Health Medi-Cal $0.37
Rate for Payer: EPIC Health Plan Commercial $0.17
Rate for Payer: EPIC Health Plan Transplant $0.17
Rate for Payer: Galaxy Health WC $0.37
Rate for Payer: Global Benefits Group Commercial $0.26
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.32
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.10
Rate for Payer: Multiplan Commercial $0.34
Rate for Payer: Networks By Design Commercial $0.28
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 47781-587-20
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of CA HMO/PPO $0.16
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.20
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.13
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.13
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.14
Rate for Payer: Blue Distinction Transplant $0.14
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.14
Rate for Payer: Cash Price $0.11
Rate for Payer: Cigna of CA HMO $0.15
Rate for Payer: Cigna of CA PPO $0.18
Rate for Payer: Dignity Health Commercial/Exchange $0.20
Rate for Payer: Dignity Health Media $0.20
Rate for Payer: Dignity Health Medi-Cal $0.20
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: EPIC Health Plan Transplant $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.18
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.14
Rate for Payer: TriValley Medical Group Commercial/Senior $0.14
Rate for Payer: United Healthcare All Other Commercial $0.12
Rate for Payer: United Healthcare All Other HMO $0.12
Rate for Payer: United Healthcare HMO Rider $0.12
Rate for Payer: United Healthcare Select/Navigate/Core $0.12
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.20
Rate for Payer: Vantage Medical Group Medi-Cal $0.20
Rate for Payer: Vantage Medical Group Senior $0.20
Service Code NDC 72266-122-25
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Blue Shield of California Commercial $0.16
Rate for Payer: Blue Shield of California EPN $0.12
Rate for Payer: Cash Price $0.10
Rate for Payer: EPIC Health Plan Commercial $0.09
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.18
Rate for Payer: Networks By Design Commercial $0.15
Rate for Payer: Prime Health Services Commercial $0.20
Service Code NDC 0409-1778-15
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.24
Rate for Payer: Aetna of CA HMO/PPO $0.18
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.24
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.15
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.15
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.17
Rate for Payer: Blue Distinction Transplant $0.17
Rate for Payer: Blue Shield of California Commercial $0.21
Rate for Payer: Blue Shield of California EPN $0.16
Rate for Payer: Cash Price $0.13
Rate for Payer: Cigna of CA HMO $0.18
Rate for Payer: Cigna of CA PPO $0.21
Rate for Payer: Dignity Health Commercial/Exchange $0.24
Rate for Payer: Dignity Health Media $0.24
Rate for Payer: Dignity Health Medi-Cal $0.24
Rate for Payer: EPIC Health Plan Commercial $0.11
Rate for Payer: EPIC Health Plan Transplant $0.11
Rate for Payer: Galaxy Health WC $0.24
Rate for Payer: Global Benefits Group Commercial $0.17
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.21
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.11
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Multiplan Commercial $0.22
Rate for Payer: Networks By Design Commercial $0.18
Rate for Payer: Prime Health Services Commercial $0.24
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.17
Rate for Payer: TriValley Medical Group Commercial/Senior $0.17
Rate for Payer: United Healthcare All Other Commercial $0.14
Rate for Payer: United Healthcare All Other HMO $0.14
Rate for Payer: United Healthcare HMO Rider $0.14
Rate for Payer: United Healthcare Select/Navigate/Core $0.14
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.24
Rate for Payer: Vantage Medical Group Medi-Cal $0.24
Rate for Payer: Vantage Medical Group Senior $0.24
Service Code NDC 72611-740-01
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of CA HMO/PPO $0.16
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.20
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.13
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.13
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.14
Rate for Payer: Blue Distinction Transplant $0.14
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.14
Rate for Payer: Cash Price $0.11
Rate for Payer: Cigna of CA HMO $0.15
Rate for Payer: Cigna of CA PPO $0.18
Rate for Payer: Dignity Health Commercial/Exchange $0.20
Rate for Payer: Dignity Health Media $0.20
Rate for Payer: Dignity Health Medi-Cal $0.20
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: EPIC Health Plan Transplant $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.18
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.14
Rate for Payer: TriValley Medical Group Commercial/Senior $0.14
Rate for Payer: United Healthcare All Other Commercial $0.12
Rate for Payer: United Healthcare All Other HMO $0.12
Rate for Payer: United Healthcare HMO Rider $0.12
Rate for Payer: United Healthcare Select/Navigate/Core $0.12
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.20
Rate for Payer: Vantage Medical Group Medi-Cal $0.20
Rate for Payer: Vantage Medical Group Senior $0.20
Service Code NDC 72611-740-10
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Blue Shield of California Commercial $0.17
Rate for Payer: Blue Shield of California EPN $0.12
Rate for Payer: Cash Price $0.11
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Service Code NDC 70860-300-41
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.37
Rate for Payer: Blue Shield of California Commercial $0.31
Rate for Payer: Blue Shield of California EPN $0.22
Rate for Payer: Cash Price $0.19
Rate for Payer: EPIC Health Plan Commercial $0.17
Rate for Payer: Galaxy Health WC $0.37
Rate for Payer: Global Benefits Group Commercial $0.26
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.16
Rate for Payer: LLUH Dept of Risk Management WC $0.10
Rate for Payer: Multiplan Commercial $0.34
Rate for Payer: Networks By Design Commercial $0.28
Rate for Payer: Prime Health Services Commercial $0.37
Service Code NDC 36000-033-10
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.26
Rate for Payer: Blue Shield of California Commercial $0.22
Rate for Payer: Blue Shield of California EPN $0.16
Rate for Payer: Cash Price $0.14
Rate for Payer: EPIC Health Plan Commercial $0.12
Rate for Payer: Galaxy Health WC $0.26
Rate for Payer: Global Benefits Group Commercial $0.19
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.12
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: Multiplan Commercial $0.25
Rate for Payer: Networks By Design Commercial $0.20
Rate for Payer: Prime Health Services Commercial $0.26
Service Code NDC 72611-740-10
Hospital Charge Code 1720138
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of CA HMO/PPO $0.16
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.20
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.13
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.13
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.14
Rate for Payer: Blue Distinction Transplant $0.14
Rate for Payer: Blue Shield of California Commercial $0.18
Rate for Payer: Blue Shield of California EPN $0.14
Rate for Payer: Cash Price $0.11
Rate for Payer: Cigna of CA HMO $0.15
Rate for Payer: Cigna of CA PPO $0.18
Rate for Payer: Dignity Health Commercial/Exchange $0.20
Rate for Payer: Dignity Health Media $0.20
Rate for Payer: Dignity Health Medi-Cal $0.20
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: EPIC Health Plan Transplant $0.10
Rate for Payer: Galaxy Health WC $0.20
Rate for Payer: Global Benefits Group Commercial $0.14
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.18
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.09
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.19
Rate for Payer: Networks By Design Commercial $0.16
Rate for Payer: Prime Health Services Commercial $0.20
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.14
Rate for Payer: TriValley Medical Group Commercial/Senior $0.14
Rate for Payer: United Healthcare All Other Commercial $0.12
Rate for Payer: United Healthcare All Other HMO $0.12
Rate for Payer: United Healthcare HMO Rider $0.12
Rate for Payer: United Healthcare Select/Navigate/Core $0.12
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.20
Rate for Payer: Vantage Medical Group Medi-Cal $0.20
Rate for Payer: Vantage Medical Group Senior $0.20