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Service Code NDC 0409-3375-04
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.62
Max. Negotiated Rate $5.73
Rate for Payer: Blue Shield of California Commercial $4.80
Rate for Payer: Blue Shield of California EPN $3.45
Rate for Payer: Cash Price $3.03
Rate for Payer: EPIC Health Plan Commercial $2.70
Rate for Payer: Galaxy Health WC $5.73
Rate for Payer: Global Benefits Group Commercial $4.04
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $4.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.57
Rate for Payer: LLUH Dept of Risk Management WC $1.62
Rate for Payer: Multiplan Commercial $5.39
Rate for Payer: Networks By Design Commercial $4.38
Rate for Payer: Prime Health Services Commercial $5.73
Service Code NDC 67457-852-00
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.26
Max. Negotiated Rate $4.45
Rate for Payer: Aetna of CA HMO/PPO $3.44
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $4.45
Rate for Payer: Alpha Care Medical Group Medi-Cal $2.88
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $2.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3.12
Rate for Payer: Blue Distinction Transplant $3.14
Rate for Payer: Blue Shield of California Commercial $3.86
Rate for Payer: Blue Shield of California EPN $3.06
Rate for Payer: Cash Price $2.36
Rate for Payer: Cigna of CA HMO $3.35
Rate for Payer: Cigna of CA PPO $3.88
Rate for Payer: Dignity Health Commercial/Exchange $4.45
Rate for Payer: Dignity Health Media $4.45
Rate for Payer: Dignity Health Medi-Cal $4.45
Rate for Payer: EPIC Health Plan Commercial $2.10
Rate for Payer: EPIC Health Plan Transplant $2.10
Rate for Payer: Galaxy Health WC $4.45
Rate for Payer: Global Benefits Group Commercial $3.14
Rate for Payer: Health Plan of Nevada (Sierra) Other $3.93
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $3.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.00
Rate for Payer: LLUH Dept of Risk Management WC $1.26
Rate for Payer: Multiplan Commercial $4.19
Rate for Payer: Networks By Design Commercial $3.41
Rate for Payer: Prime Health Services Commercial $4.45
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $3.14
Rate for Payer: TriValley Medical Group Commercial/Senior $3.14
Rate for Payer: United Healthcare All Other Commercial $2.62
Rate for Payer: United Healthcare All Other HMO $2.62
Rate for Payer: United Healthcare HMO Rider $2.62
Rate for Payer: United Healthcare Select/Navigate/Core $2.62
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.45
Rate for Payer: Vantage Medical Group Medi-Cal $4.45
Rate for Payer: Vantage Medical Group Senior $4.45
Service Code NDC 63323-940-21
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $0.76
Max. Negotiated Rate $2.68
Rate for Payer: Blue Shield of California Commercial $2.24
Rate for Payer: Blue Shield of California EPN $1.61
Rate for Payer: Cash Price $1.42
Rate for Payer: EPIC Health Plan Commercial $1.26
Rate for Payer: Galaxy Health WC $2.68
Rate for Payer: Global Benefits Group Commercial $1.89
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.20
Rate for Payer: LLUH Dept of Risk Management WC $0.76
Rate for Payer: Multiplan Commercial $2.52
Rate for Payer: Networks By Design Commercial $2.05
Rate for Payer: Prime Health Services Commercial $2.68
Service Code NDC 70121-1576-1
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.30
Max. Negotiated Rate $4.60
Rate for Payer: Blue Shield of California Commercial $3.85
Rate for Payer: Blue Shield of California EPN $2.77
Rate for Payer: Cash Price $2.43
Rate for Payer: EPIC Health Plan Commercial $2.16
Rate for Payer: Galaxy Health WC $4.60
Rate for Payer: Global Benefits Group Commercial $3.25
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $3.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.06
Rate for Payer: LLUH Dept of Risk Management WC $1.30
Rate for Payer: Multiplan Commercial $4.33
Rate for Payer: Networks By Design Commercial $3.52
Rate for Payer: Prime Health Services Commercial $4.60
Service Code NDC 70121-1576-7
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.30
Max. Negotiated Rate $4.60
Rate for Payer: Aetna of CA HMO/PPO $3.55
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $4.60
Rate for Payer: Alpha Care Medical Group Medi-Cal $2.98
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $2.98
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3.22
Rate for Payer: Blue Distinction Transplant $3.25
Rate for Payer: Blue Shield of California Commercial $3.99
Rate for Payer: Blue Shield of California EPN $3.16
Rate for Payer: Cash Price $2.43
Rate for Payer: Cigna of CA HMO $3.46
Rate for Payer: Cigna of CA PPO $4.00
Rate for Payer: Dignity Health Commercial/Exchange $4.60
Rate for Payer: Dignity Health Media $4.60
Rate for Payer: Dignity Health Medi-Cal $4.60
Rate for Payer: EPIC Health Plan Commercial $2.16
Rate for Payer: EPIC Health Plan Transplant $2.16
Rate for Payer: Galaxy Health WC $4.60
Rate for Payer: Global Benefits Group Commercial $3.25
Rate for Payer: Health Plan of Nevada (Sierra) Other $4.06
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $3.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.06
Rate for Payer: LLUH Dept of Risk Management WC $1.30
Rate for Payer: Multiplan Commercial $4.33
Rate for Payer: Networks By Design Commercial $3.52
Rate for Payer: Prime Health Services Commercial $4.60
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $3.25
Rate for Payer: TriValley Medical Group Commercial/Senior $3.25
Rate for Payer: United Healthcare All Other Commercial $2.70
Rate for Payer: United Healthcare All Other HMO $2.70
Rate for Payer: United Healthcare HMO Rider $2.70
Rate for Payer: United Healthcare Select/Navigate/Core $2.70
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.60
Rate for Payer: Vantage Medical Group Medi-Cal $4.60
Rate for Payer: Vantage Medical Group Senior $4.60
Service Code NDC 25021-316-04
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $0.63
Max. Negotiated Rate $2.23
Rate for Payer: Blue Shield of California Commercial $1.87
Rate for Payer: Blue Shield of California EPN $1.34
Rate for Payer: Cash Price $1.18
Rate for Payer: EPIC Health Plan Commercial $1.05
Rate for Payer: Galaxy Health WC $2.23
Rate for Payer: Global Benefits Group Commercial $1.57
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.00
Rate for Payer: LLUH Dept of Risk Management WC $0.63
Rate for Payer: Multiplan Commercial $2.10
Rate for Payer: Networks By Design Commercial $1.70
Rate for Payer: Prime Health Services Commercial $2.23
Service Code NDC 0409-3375-14
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.62
Max. Negotiated Rate $5.73
Rate for Payer: Aetna of CA HMO/PPO $4.42
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $5.73
Rate for Payer: Alpha Care Medical Group Medi-Cal $3.71
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $3.71
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4.02
Rate for Payer: Blue Distinction Transplant $4.04
Rate for Payer: Blue Shield of California Commercial $4.97
Rate for Payer: Blue Shield of California EPN $3.94
Rate for Payer: Cash Price $3.03
Rate for Payer: Cigna of CA HMO $4.31
Rate for Payer: Cigna of CA PPO $4.99
Rate for Payer: Dignity Health Commercial/Exchange $5.73
Rate for Payer: Dignity Health Media $5.73
Rate for Payer: Dignity Health Medi-Cal $5.73
Rate for Payer: EPIC Health Plan Commercial $2.70
Rate for Payer: EPIC Health Plan Transplant $2.70
Rate for Payer: Galaxy Health WC $5.73
Rate for Payer: Global Benefits Group Commercial $4.04
Rate for Payer: Health Plan of Nevada (Sierra) Other $5.06
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $4.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.57
Rate for Payer: LLUH Dept of Risk Management WC $1.62
Rate for Payer: Multiplan Commercial $5.39
Rate for Payer: Networks By Design Commercial $4.38
Rate for Payer: Prime Health Services Commercial $5.73
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $4.04
Rate for Payer: TriValley Medical Group Commercial/Senior $4.04
Rate for Payer: United Healthcare All Other Commercial $3.37
Rate for Payer: United Healthcare All Other HMO $3.37
Rate for Payer: United Healthcare HMO Rider $3.37
Rate for Payer: United Healthcare Select/Navigate/Core $3.37
Rate for Payer: Vantage Medical Group Commercial/Exchange $5.73
Rate for Payer: Vantage Medical Group Medi-Cal $5.73
Rate for Payer: Vantage Medical Group Senior $5.73
Service Code NDC 63323-940-04
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $0.76
Max. Negotiated Rate $2.68
Rate for Payer: Blue Shield of California Commercial $2.24
Rate for Payer: Blue Shield of California EPN $1.61
Rate for Payer: Cash Price $1.42
Rate for Payer: EPIC Health Plan Commercial $1.26
Rate for Payer: Galaxy Health WC $2.68
Rate for Payer: Global Benefits Group Commercial $1.89
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.20
Rate for Payer: LLUH Dept of Risk Management WC $0.76
Rate for Payer: Multiplan Commercial $2.52
Rate for Payer: Networks By Design Commercial $2.05
Rate for Payer: Prime Health Services Commercial $2.68
Service Code NDC 63323-940-04
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $0.76
Max. Negotiated Rate $2.68
Rate for Payer: Aetna of CA HMO/PPO $2.07
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $2.68
Rate for Payer: Alpha Care Medical Group Medi-Cal $1.73
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $1.73
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $1.88
Rate for Payer: Blue Distinction Transplant $1.89
Rate for Payer: Blue Shield of California Commercial $2.32
Rate for Payer: Blue Shield of California EPN $1.84
Rate for Payer: Cash Price $1.42
Rate for Payer: Cigna of CA HMO $2.02
Rate for Payer: Cigna of CA PPO $2.33
Rate for Payer: Dignity Health Commercial/Exchange $2.68
Rate for Payer: Dignity Health Media $2.68
Rate for Payer: Dignity Health Medi-Cal $2.68
Rate for Payer: EPIC Health Plan Commercial $1.26
Rate for Payer: EPIC Health Plan Transplant $1.26
Rate for Payer: Galaxy Health WC $2.68
Rate for Payer: Global Benefits Group Commercial $1.89
Rate for Payer: Health Plan of Nevada (Sierra) Other $2.36
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.20
Rate for Payer: LLUH Dept of Risk Management WC $0.76
Rate for Payer: Multiplan Commercial $2.52
Rate for Payer: Networks By Design Commercial $2.05
Rate for Payer: Prime Health Services Commercial $2.68
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $1.89
Rate for Payer: TriValley Medical Group Commercial/Senior $1.89
Rate for Payer: United Healthcare All Other Commercial $1.58
Rate for Payer: United Healthcare All Other HMO $1.58
Rate for Payer: United Healthcare HMO Rider $1.58
Rate for Payer: United Healthcare Select/Navigate/Core $1.58
Rate for Payer: Vantage Medical Group Commercial/Exchange $2.68
Rate for Payer: Vantage Medical Group Medi-Cal $2.68
Rate for Payer: Vantage Medical Group Senior $2.68
Service Code NDC 43066-997-01
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $0.36
Max. Negotiated Rate $1.28
Rate for Payer: Blue Shield of California Commercial $1.07
Rate for Payer: Blue Shield of California EPN $0.77
Rate for Payer: Cash Price $0.68
Rate for Payer: EPIC Health Plan Commercial $0.60
Rate for Payer: Galaxy Health WC $1.28
Rate for Payer: Global Benefits Group Commercial $0.90
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.57
Rate for Payer: LLUH Dept of Risk Management WC $0.36
Rate for Payer: Multiplan Commercial $1.20
Rate for Payer: Networks By Design Commercial $0.98
Rate for Payer: Prime Health Services Commercial $1.28
Service Code NDC 0409-3375-04
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.62
Max. Negotiated Rate $5.73
Rate for Payer: Aetna of CA HMO/PPO $4.42
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $5.73
Rate for Payer: Alpha Care Medical Group Medi-Cal $3.71
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $3.71
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4.02
Rate for Payer: Blue Distinction Transplant $4.04
Rate for Payer: Blue Shield of California Commercial $4.97
Rate for Payer: Blue Shield of California EPN $3.94
Rate for Payer: Cash Price $3.03
Rate for Payer: Cigna of CA HMO $4.31
Rate for Payer: Cigna of CA PPO $4.99
Rate for Payer: Dignity Health Commercial/Exchange $5.73
Rate for Payer: Dignity Health Media $5.73
Rate for Payer: Dignity Health Medi-Cal $5.73
Rate for Payer: EPIC Health Plan Commercial $2.70
Rate for Payer: EPIC Health Plan Transplant $2.70
Rate for Payer: Galaxy Health WC $5.73
Rate for Payer: Global Benefits Group Commercial $4.04
Rate for Payer: Health Plan of Nevada (Sierra) Other $5.06
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $4.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.57
Rate for Payer: LLUH Dept of Risk Management WC $1.62
Rate for Payer: Multiplan Commercial $5.39
Rate for Payer: Networks By Design Commercial $4.38
Rate for Payer: Prime Health Services Commercial $5.73
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $4.04
Rate for Payer: TriValley Medical Group Commercial/Senior $4.04
Rate for Payer: United Healthcare All Other Commercial $3.37
Rate for Payer: United Healthcare All Other HMO $3.37
Rate for Payer: United Healthcare HMO Rider $3.37
Rate for Payer: United Healthcare Select/Navigate/Core $3.37
Rate for Payer: Vantage Medical Group Commercial/Exchange $5.73
Rate for Payer: Vantage Medical Group Medi-Cal $5.73
Rate for Payer: Vantage Medical Group Senior $5.73
Service Code NDC 0409-3375-14
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.62
Max. Negotiated Rate $5.73
Rate for Payer: Blue Shield of California Commercial $4.80
Rate for Payer: Blue Shield of California EPN $3.45
Rate for Payer: Cash Price $3.03
Rate for Payer: EPIC Health Plan Commercial $2.70
Rate for Payer: Galaxy Health WC $5.73
Rate for Payer: Global Benefits Group Commercial $4.04
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $4.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.57
Rate for Payer: LLUH Dept of Risk Management WC $1.62
Rate for Payer: Multiplan Commercial $5.39
Rate for Payer: Networks By Design Commercial $4.38
Rate for Payer: Prime Health Services Commercial $5.73
Service Code NDC 0143-9318-01
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.04
Max. Negotiated Rate $3.68
Rate for Payer: Blue Shield of California Commercial $3.08
Rate for Payer: Blue Shield of California EPN $2.22
Rate for Payer: Cash Price $1.95
Rate for Payer: EPIC Health Plan Commercial $1.73
Rate for Payer: Galaxy Health WC $3.68
Rate for Payer: Global Benefits Group Commercial $2.60
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.65
Rate for Payer: LLUH Dept of Risk Management WC $1.04
Rate for Payer: Multiplan Commercial $3.46
Rate for Payer: Networks By Design Commercial $2.81
Rate for Payer: Prime Health Services Commercial $3.68
Service Code NDC 0143-9318-10
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.04
Max. Negotiated Rate $3.68
Rate for Payer: Blue Shield of California Commercial $3.08
Rate for Payer: Blue Shield of California EPN $2.22
Rate for Payer: Cash Price $1.95
Rate for Payer: EPIC Health Plan Commercial $1.73
Rate for Payer: Galaxy Health WC $3.68
Rate for Payer: Global Benefits Group Commercial $2.60
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.65
Rate for Payer: LLUH Dept of Risk Management WC $1.04
Rate for Payer: Multiplan Commercial $3.46
Rate for Payer: Networks By Design Commercial $2.81
Rate for Payer: Prime Health Services Commercial $3.68
Service Code NDC 43066-997-10
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $0.36
Max. Negotiated Rate $1.28
Rate for Payer: Blue Shield of California Commercial $1.07
Rate for Payer: Blue Shield of California EPN $0.77
Rate for Payer: Cash Price $0.68
Rate for Payer: EPIC Health Plan Commercial $0.60
Rate for Payer: Galaxy Health WC $1.28
Rate for Payer: Global Benefits Group Commercial $0.90
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.57
Rate for Payer: LLUH Dept of Risk Management WC $0.36
Rate for Payer: Multiplan Commercial $1.20
Rate for Payer: Networks By Design Commercial $0.98
Rate for Payer: Prime Health Services Commercial $1.28
Service Code NDC 67457-852-04
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.26
Max. Negotiated Rate $4.45
Rate for Payer: Blue Shield of California Commercial $3.73
Rate for Payer: Blue Shield of California EPN $2.68
Rate for Payer: Cash Price $2.36
Rate for Payer: EPIC Health Plan Commercial $2.10
Rate for Payer: Galaxy Health WC $4.45
Rate for Payer: Global Benefits Group Commercial $3.14
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $3.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.00
Rate for Payer: LLUH Dept of Risk Management WC $1.26
Rate for Payer: Multiplan Commercial $4.19
Rate for Payer: Networks By Design Commercial $3.41
Rate for Payer: Prime Health Services Commercial $4.45
Service Code NDC 0143-9318-10
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.04
Max. Negotiated Rate $3.68
Rate for Payer: Aetna of CA HMO/PPO $2.84
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $3.68
Rate for Payer: Alpha Care Medical Group Medi-Cal $2.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $2.38
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $2.58
Rate for Payer: Blue Distinction Transplant $2.60
Rate for Payer: Blue Shield of California Commercial $3.19
Rate for Payer: Blue Shield of California EPN $2.53
Rate for Payer: Cash Price $1.95
Rate for Payer: Cigna of CA HMO $2.77
Rate for Payer: Cigna of CA PPO $3.20
Rate for Payer: Dignity Health Commercial/Exchange $3.68
Rate for Payer: Dignity Health Media $3.68
Rate for Payer: Dignity Health Medi-Cal $3.68
Rate for Payer: EPIC Health Plan Commercial $1.73
Rate for Payer: EPIC Health Plan Transplant $1.73
Rate for Payer: Galaxy Health WC $3.68
Rate for Payer: Global Benefits Group Commercial $2.60
Rate for Payer: Health Plan of Nevada (Sierra) Other $3.25
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.65
Rate for Payer: LLUH Dept of Risk Management WC $1.04
Rate for Payer: Multiplan Commercial $3.46
Rate for Payer: Networks By Design Commercial $2.81
Rate for Payer: Prime Health Services Commercial $3.68
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $2.60
Rate for Payer: TriValley Medical Group Commercial/Senior $2.60
Rate for Payer: United Healthcare All Other Commercial $2.16
Rate for Payer: United Healthcare All Other HMO $2.16
Rate for Payer: United Healthcare HMO Rider $2.16
Rate for Payer: United Healthcare Select/Navigate/Core $2.16
Rate for Payer: Vantage Medical Group Commercial/Exchange $3.68
Rate for Payer: Vantage Medical Group Medi-Cal $3.68
Rate for Payer: Vantage Medical Group Senior $3.68
Service Code NDC 70121-1576-1
Hospital Charge Code 1720130
Hospital Revenue Code 250
Min. Negotiated Rate $1.30
Max. Negotiated Rate $4.60
Rate for Payer: Aetna of CA HMO/PPO $3.55
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $4.60
Rate for Payer: Alpha Care Medical Group Medi-Cal $2.98
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $2.98
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3.22
Rate for Payer: Blue Distinction Transplant $3.25
Rate for Payer: Blue Shield of California Commercial $3.99
Rate for Payer: Blue Shield of California EPN $3.16
Rate for Payer: Cash Price $2.43
Rate for Payer: Cigna of CA HMO $3.46
Rate for Payer: Cigna of CA PPO $4.00
Rate for Payer: Dignity Health Commercial/Exchange $4.60
Rate for Payer: Dignity Health Media $4.60
Rate for Payer: Dignity Health Medi-Cal $4.60
Rate for Payer: EPIC Health Plan Commercial $2.16
Rate for Payer: EPIC Health Plan Transplant $2.16
Rate for Payer: Galaxy Health WC $4.60
Rate for Payer: Global Benefits Group Commercial $3.25
Rate for Payer: Health Plan of Nevada (Sierra) Other $4.06
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $3.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal $2.06
Rate for Payer: LLUH Dept of Risk Management WC $1.30
Rate for Payer: Multiplan Commercial $4.33
Rate for Payer: Networks By Design Commercial $3.52
Rate for Payer: Prime Health Services Commercial $4.60
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $3.25
Rate for Payer: TriValley Medical Group Commercial/Senior $3.25
Rate for Payer: United Healthcare All Other Commercial $2.70
Rate for Payer: United Healthcare All Other HMO $2.70
Rate for Payer: United Healthcare HMO Rider $2.70
Rate for Payer: United Healthcare Select/Navigate/Core $2.70
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.60
Rate for Payer: Vantage Medical Group Medi-Cal $4.60
Rate for Payer: Vantage Medical Group Senior $4.60
Service Code NDC 9994-0814-06
Hospital Charge Code NDC121298A
Hospital Revenue Code 250
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 9994-0814-06
Hospital Charge Code NDC121298A
Hospital Revenue Code 250
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: 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 0555-9008-79
Hospital Charge Code 1710118
Hospital Revenue Code 259
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.79
Rate for Payer: Blue Shield of California Commercial $0.66
Rate for Payer: Blue Shield of California EPN $0.48
Rate for Payer: Cash Price $0.42
Rate for Payer: Cigna of CA HMO $0.65
Rate for Payer: Cigna of CA PPO $0.65
Rate for Payer: EPIC Health Plan Commercial $0.37
Rate for Payer: Galaxy Health WC $0.79
Rate for Payer: Global Benefits Group Commercial $0.56
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.35
Rate for Payer: LLUH Dept of Risk Management WC $0.22
Rate for Payer: Multiplan Commercial $0.74
Rate for Payer: Networks By Design Commercial $0.60
Rate for Payer: Prime Health Services Commercial $0.79
Service Code NDC 0555-9008-79
Hospital Charge Code 1710118
Hospital Revenue Code 259
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.79
Rate for Payer: Aetna of CA HMO/PPO $0.61
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.79
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.51
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.51
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.55
Rate for Payer: Blue Distinction Transplant $0.56
Rate for Payer: Blue Shield of California Commercial $0.69
Rate for Payer: Blue Shield of California EPN $0.54
Rate for Payer: Cash Price $0.42
Rate for Payer: Cigna of CA HMO $0.65
Rate for Payer: Cigna of CA PPO $0.65
Rate for Payer: Dignity Health Commercial/Exchange $0.79
Rate for Payer: Dignity Health Media $0.79
Rate for Payer: Dignity Health Medi-Cal $0.79
Rate for Payer: EPIC Health Plan Commercial $0.37
Rate for Payer: EPIC Health Plan Transplant $0.37
Rate for Payer: Galaxy Health WC $0.79
Rate for Payer: Global Benefits Group Commercial $0.56
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.70
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.35
Rate for Payer: LLUH Dept of Risk Management WC $0.22
Rate for Payer: Multiplan Commercial $0.74
Rate for Payer: Networks By Design Commercial $0.60
Rate for Payer: Prime Health Services Commercial $0.79
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.56
Rate for Payer: TriValley Medical Group Commercial/Senior $0.56
Rate for Payer: United Healthcare All Other Commercial $0.47
Rate for Payer: United Healthcare All Other HMO $0.47
Rate for Payer: United Healthcare HMO Rider $0.47
Rate for Payer: United Healthcare Select/Navigate/Core $0.47
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.79
Rate for Payer: Vantage Medical Group Medi-Cal $0.79
Rate for Payer: Vantage Medical Group Senior $0.79
Service Code NDC 68462-304-50
Hospital Charge Code 1710200
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.61
Rate for Payer: Aetna of CA HMO/PPO $0.47
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.61
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.40
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.40
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.43
Rate for Payer: Blue Distinction Transplant $0.43
Rate for Payer: Blue Shield of California Commercial $0.53
Rate for Payer: Blue Shield of California EPN $0.42
Rate for Payer: Cash Price $0.32
Rate for Payer: Cigna of CA HMO $0.50
Rate for Payer: Cigna of CA PPO $0.50
Rate for Payer: Dignity Health Commercial/Exchange $0.61
Rate for Payer: Dignity Health Media $0.61
Rate for Payer: Dignity Health Medi-Cal $0.61
Rate for Payer: EPIC Health Plan Commercial $0.29
Rate for Payer: EPIC Health Plan Transplant $0.29
Rate for Payer: Galaxy Health WC $0.61
Rate for Payer: Global Benefits Group Commercial $0.43
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.54
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.27
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Multiplan Commercial $0.58
Rate for Payer: Networks By Design Commercial $0.47
Rate for Payer: Prime Health Services Commercial $0.61
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.43
Rate for Payer: TriValley Medical Group Commercial/Senior $0.43
Rate for Payer: United Healthcare All Other Commercial $0.36
Rate for Payer: United Healthcare All Other HMO $0.36
Rate for Payer: United Healthcare HMO Rider $0.36
Rate for Payer: United Healthcare Select/Navigate/Core $0.36
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.61
Rate for Payer: Vantage Medical Group Medi-Cal $0.61
Rate for Payer: Vantage Medical Group Senior $0.61
Service Code NDC 0555-0211-10
Hospital Charge Code 1710200
Hospital Revenue Code 259
Min. Negotiated Rate $0.54
Max. Negotiated Rate $1.90
Rate for Payer: Blue Shield of California Commercial $1.59
Rate for Payer: Blue Shield of California EPN $1.14
Rate for Payer: Cash Price $1.00
Rate for Payer: Cigna of CA HMO $1.56
Rate for Payer: Cigna of CA PPO $1.56
Rate for Payer: EPIC Health Plan Commercial $0.89
Rate for Payer: Galaxy Health WC $1.90
Rate for Payer: Global Benefits Group Commercial $1.34
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.85
Rate for Payer: LLUH Dept of Risk Management WC $0.54
Rate for Payer: Multiplan Commercial $1.78
Rate for Payer: Networks By Design Commercial $1.45
Rate for Payer: Prime Health Services Commercial $1.90
Service Code NDC 68462-304-50
Hospital Charge Code 1710200
Hospital Revenue Code 259
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.61
Rate for Payer: Blue Shield of California Commercial $0.51
Rate for Payer: Blue Shield of California EPN $0.37
Rate for Payer: Cash Price $0.32
Rate for Payer: Cigna of CA HMO $0.50
Rate for Payer: Cigna of CA PPO $0.50
Rate for Payer: EPIC Health Plan Commercial $0.29
Rate for Payer: Galaxy Health WC $0.61
Rate for Payer: Global Benefits Group Commercial $0.43
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.27
Rate for Payer: LLUH Dept of Risk Management WC $0.17
Rate for Payer: Multiplan Commercial $0.58
Rate for Payer: Networks By Design Commercial $0.47
Rate for Payer: Prime Health Services Commercial $0.61