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Service Code NDC 69238-1266-1
Hospital Charge Code 1712299
Hospital Revenue Code 259
Min. Negotiated Rate $2.50
Max. Negotiated Rate $8.85
Rate for Payer: Blue Shield of California Commercial $7.41
Rate for Payer: Blue Shield of California EPN $5.33
Rate for Payer: Cash Price $4.68
Rate for Payer: Cigna of CA HMO $7.29
Rate for Payer: Cigna of CA PPO $7.29
Rate for Payer: EPIC Health Plan Commercial $4.16
Rate for Payer: Galaxy Health WC $8.85
Rate for Payer: Global Benefits Group Commercial $6.25
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $6.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal $3.97
Rate for Payer: LLUH Dept of Risk Management WC $2.50
Rate for Payer: Multiplan Commercial $8.33
Rate for Payer: Networks By Design Commercial $6.77
Rate for Payer: Prime Health Services Commercial $8.85
Service Code NDC 0004-0800-85
Hospital Charge Code 1712299
Hospital Revenue Code 259
Min. Negotiated Rate $4.38
Max. Negotiated Rate $15.50
Rate for Payer: Aetna of CA HMO/PPO $11.96
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $15.50
Rate for Payer: Alpha Care Medical Group Medi-Cal $10.03
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $10.03
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10.86
Rate for Payer: Blue Distinction Transplant $10.94
Rate for Payer: Blue Shield of California Commercial $13.44
Rate for Payer: Blue Shield of California EPN $10.65
Rate for Payer: Cash Price $8.20
Rate for Payer: Cigna of CA HMO $12.76
Rate for Payer: Cigna of CA PPO $12.76
Rate for Payer: Dignity Health Commercial/Exchange $15.50
Rate for Payer: Dignity Health Media $15.50
Rate for Payer: Dignity Health Medi-Cal $15.50
Rate for Payer: EPIC Health Plan Commercial $7.29
Rate for Payer: EPIC Health Plan Transplant $7.29
Rate for Payer: Galaxy Health WC $15.50
Rate for Payer: Global Benefits Group Commercial $10.94
Rate for Payer: Health Plan of Nevada (Sierra) Other $13.67
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $12.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $6.95
Rate for Payer: LLUH Dept of Risk Management WC $4.38
Rate for Payer: Multiplan Commercial $14.58
Rate for Payer: Networks By Design Commercial $11.85
Rate for Payer: Prime Health Services Commercial $15.50
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $10.94
Rate for Payer: TriValley Medical Group Commercial/Senior $10.94
Rate for Payer: United Healthcare All Other Commercial $9.12
Rate for Payer: United Healthcare All Other HMO $9.12
Rate for Payer: United Healthcare HMO Rider $9.12
Rate for Payer: United Healthcare Select/Navigate/Core $9.12
Rate for Payer: Vantage Medical Group Commercial/Exchange $15.50
Rate for Payer: Vantage Medical Group Medi-Cal $15.50
Rate for Payer: Vantage Medical Group Senior $15.50
Service Code NDC 31722-632-31
Hospital Charge Code 1712299
Hospital Revenue Code 259
Min. Negotiated Rate $0.75
Max. Negotiated Rate $2.65
Rate for Payer: Aetna of CA HMO/PPO $2.05
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $2.65
Rate for Payer: Alpha Care Medical Group Medi-Cal $1.72
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $1.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $1.86
Rate for Payer: Blue Distinction Transplant $1.87
Rate for Payer: Blue Shield of California Commercial $2.30
Rate for Payer: Blue Shield of California EPN $1.82
Rate for Payer: Cash Price $1.40
Rate for Payer: Cigna of CA HMO $2.18
Rate for Payer: Cigna of CA PPO $2.18
Rate for Payer: Dignity Health Commercial/Exchange $2.65
Rate for Payer: Dignity Health Media $2.65
Rate for Payer: Dignity Health Medi-Cal $2.65
Rate for Payer: EPIC Health Plan Commercial $1.25
Rate for Payer: EPIC Health Plan Transplant $1.25
Rate for Payer: Galaxy Health WC $2.65
Rate for Payer: Global Benefits Group Commercial $1.87
Rate for Payer: Health Plan of Nevada (Sierra) Other $2.34
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.19
Rate for Payer: LLUH Dept of Risk Management WC $0.75
Rate for Payer: Multiplan Commercial $2.50
Rate for Payer: Networks By Design Commercial $2.03
Rate for Payer: Prime Health Services Commercial $2.65
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $1.87
Rate for Payer: TriValley Medical Group Commercial/Senior $1.87
Rate for Payer: United Healthcare All Other Commercial $1.56
Rate for Payer: United Healthcare All Other HMO $1.56
Rate for Payer: United Healthcare HMO Rider $1.56
Rate for Payer: United Healthcare Select/Navigate/Core $1.56
Rate for Payer: Vantage Medical Group Commercial/Exchange $2.65
Rate for Payer: Vantage Medical Group Medi-Cal $2.65
Rate for Payer: Vantage Medical Group Senior $2.65
Service Code NDC 0004-0800-85
Hospital Charge Code 1712299
Hospital Revenue Code 259
Min. Negotiated Rate $4.38
Max. Negotiated Rate $15.50
Rate for Payer: Blue Shield of California Commercial $12.98
Rate for Payer: Blue Shield of California EPN $9.33
Rate for Payer: Cash Price $8.20
Rate for Payer: Cigna of CA HMO $12.76
Rate for Payer: Cigna of CA PPO $12.76
Rate for Payer: EPIC Health Plan Commercial $7.29
Rate for Payer: Galaxy Health WC $15.50
Rate for Payer: Global Benefits Group Commercial $10.94
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $12.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal $6.95
Rate for Payer: LLUH Dept of Risk Management WC $4.38
Rate for Payer: Multiplan Commercial $14.58
Rate for Payer: Networks By Design Commercial $11.85
Rate for Payer: Prime Health Services Commercial $15.50
Service Code NDC 31722-632-31
Hospital Charge Code 1712299
Hospital Revenue Code 259
Min. Negotiated Rate $0.75
Max. Negotiated Rate $2.65
Rate for Payer: Blue Shield of California Commercial $2.22
Rate for Payer: Blue Shield of California EPN $1.60
Rate for Payer: Cash Price $1.40
Rate for Payer: Cigna of CA HMO $2.18
Rate for Payer: Cigna of CA PPO $2.18
Rate for Payer: EPIC Health Plan Commercial $1.25
Rate for Payer: Galaxy Health WC $2.65
Rate for Payer: Global Benefits Group Commercial $1.87
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $2.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal $1.19
Rate for Payer: LLUH Dept of Risk Management WC $0.75
Rate for Payer: Multiplan Commercial $2.50
Rate for Payer: Networks By Design Commercial $2.03
Rate for Payer: Prime Health Services Commercial $2.65
Service Code APR-DRG 3444
Min. Negotiated Rate $23,442.94
Max. Negotiated Rate $30,560.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $23,442.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal $30,560.26
Service Code APR-DRG 3442
Min. Negotiated Rate $10,178.74
Max. Negotiated Rate $13,269.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $10,178.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal $13,269.03
Service Code APR-DRG 3441
Min. Negotiated Rate $8,022.46
Max. Negotiated Rate $10,458.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $8,022.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal $10,458.09
Service Code APR-DRG 3443
Min. Negotiated Rate $14,600.14
Max. Negotiated Rate $19,032.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $14,600.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal $19,032.78
Service Code CPT 28300
Min. Negotiated Rate $761.12
Max. Negotiated Rate $14,659.19
Rate for Payer: Aetna of CA HMO/PPO $7,385.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $13,407.80
Rate for Payer: Alpha Care Medical Group Medi-Cal $9,832.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $8,938.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $5,938.00
Rate for Payer: Dignity Health Commercial/Exchange $13,407.80
Rate for Payer: Dignity Health Media $8,938.53
Rate for Payer: Dignity Health Medi-Cal $9,832.38
Rate for Payer: EPIC Health Plan Commercial $12,067.02
Rate for Payer: EPIC Health Plan Medicare/Senior $8,938.53
Rate for Payer: EPIC Health Plan Transplant $8,938.53
Rate for Payer: Heritage Provider Network Commercial $14,659.19
Rate for Payer: Heritage Provider Network Transplant $14,659.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $14,480.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant $14,480.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $8,938.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal $761.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $8,938.53
Rate for Payer: Molina Healthcare of CA Medi-Cal $11,262.55
Rate for Payer: Molina Healthcare of CA Medicare $11,977.63
Rate for Payer: Vantage Medical Group Commercial/Exchange $13,407.80
Rate for Payer: Vantage Medical Group Medi-Cal $9,832.38
Rate for Payer: Vantage Medical Group Senior $8,938.53
Service Code CPT 28304
Min. Negotiated Rate $640.87
Max. Negotiated Rate $14,659.19
Rate for Payer: Aetna of CA HMO/PPO $7,385.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $13,407.80
Rate for Payer: Alpha Care Medical Group Medi-Cal $9,832.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $8,938.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $5,938.00
Rate for Payer: Dignity Health Commercial/Exchange $13,407.80
Rate for Payer: Dignity Health Media $8,938.53
Rate for Payer: Dignity Health Medi-Cal $9,832.38
Rate for Payer: EPIC Health Plan Commercial $12,067.02
Rate for Payer: EPIC Health Plan Medicare/Senior $8,938.53
Rate for Payer: EPIC Health Plan Transplant $8,938.53
Rate for Payer: Heritage Provider Network Commercial $14,659.19
Rate for Payer: Heritage Provider Network Transplant $14,659.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $14,480.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant $14,480.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $8,938.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal $640.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $8,938.53
Rate for Payer: Molina Healthcare of CA Medi-Cal $11,262.55
Rate for Payer: Molina Healthcare of CA Medicare $11,977.63
Rate for Payer: Vantage Medical Group Commercial/Exchange $13,407.80
Rate for Payer: Vantage Medical Group Medi-Cal $9,832.38
Rate for Payer: Vantage Medical Group Senior $8,938.53
Service Code NDC 6845510690
Hospital Charge Code 1743626
Hospital Revenue Code 271
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.14
Rate for Payer: Cash Price $0.07
Rate for Payer: EPIC Health Plan Commercial $0.06
Rate for Payer: Galaxy Health WC $0.14
Rate for Payer: Global Benefits Group Commercial $0.10
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.06
Rate for Payer: LLUH Dept of Risk Management WC $0.04
Rate for Payer: Multiplan Commercial $0.13
Rate for Payer: Networks By Design Commercial $0.10
Rate for Payer: Prime Health Services Commercial $0.14
Service Code NDC 6845510690
Hospital Charge Code 1743626
Hospital Revenue Code 271
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.14
Rate for Payer: Aetna of CA HMO/PPO $0.10
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.14
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.09
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.09
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.10
Rate for Payer: Blue Distinction Transplant $0.10
Rate for Payer: Blue Shield of California Commercial $0.12
Rate for Payer: Blue Shield of California EPN $0.09
Rate for Payer: Cash Price $0.07
Rate for Payer: Cigna of CA HMO $0.10
Rate for Payer: Cigna of CA PPO $0.12
Rate for Payer: Dignity Health Commercial/Exchange $0.14
Rate for Payer: Dignity Health Media $0.14
Rate for Payer: Dignity Health Medi-Cal $0.14
Rate for Payer: EPIC Health Plan Commercial $0.06
Rate for Payer: EPIC Health Plan Transplant $0.06
Rate for Payer: Galaxy Health WC $0.14
Rate for Payer: Global Benefits Group Commercial $0.10
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.12
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.06
Rate for Payer: LLUH Dept of Risk Management WC $0.04
Rate for Payer: Multiplan Commercial $0.13
Rate for Payer: Networks By Design Commercial $0.10
Rate for Payer: Prime Health Services Commercial $0.14
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.10
Rate for Payer: TriValley Medical Group Commercial/Senior $0.10
Rate for Payer: United Healthcare All Other Commercial $0.08
Rate for Payer: United Healthcare All Other HMO $0.08
Rate for Payer: United Healthcare HMO Rider $0.08
Rate for Payer: United Healthcare Select/Navigate/Core $0.08
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.14
Rate for Payer: Vantage Medical Group Medi-Cal $0.14
Rate for Payer: Vantage Medical Group Senior $0.14
Service Code NDC 6845510826
Hospital Charge Code 1743566
Hospital Revenue Code 271
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.22
Rate for Payer: Cash Price $0.12
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: Galaxy Health WC $0.22
Rate for Payer: Global Benefits Group Commercial $0.16
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.21
Rate for Payer: Networks By Design Commercial $0.17
Rate for Payer: Prime Health Services Commercial $0.22
Service Code NDC 6845510826
Hospital Charge Code 1743566
Hospital Revenue Code 271
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.22
Rate for Payer: Aetna of CA HMO/PPO $0.17
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.22
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.14
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.14
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.15
Rate for Payer: Blue Distinction Transplant $0.16
Rate for Payer: Blue Shield of California Commercial $0.19
Rate for Payer: Blue Shield of California EPN $0.15
Rate for Payer: Cash Price $0.12
Rate for Payer: Cigna of CA HMO $0.17
Rate for Payer: Cigna of CA PPO $0.19
Rate for Payer: Dignity Health Commercial/Exchange $0.22
Rate for Payer: Dignity Health Media $0.22
Rate for Payer: Dignity Health Medi-Cal $0.22
Rate for Payer: EPIC Health Plan Commercial $0.10
Rate for Payer: EPIC Health Plan Transplant $0.10
Rate for Payer: Galaxy Health WC $0.22
Rate for Payer: Global Benefits Group Commercial $0.16
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.20
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.10
Rate for Payer: LLUH Dept of Risk Management WC $0.06
Rate for Payer: Multiplan Commercial $0.21
Rate for Payer: Networks By Design Commercial $0.17
Rate for Payer: Prime Health Services Commercial $0.22
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.16
Rate for Payer: TriValley Medical Group Commercial/Senior $0.16
Rate for Payer: United Healthcare All Other Commercial $0.13
Rate for Payer: United Healthcare All Other HMO $0.13
Rate for Payer: United Healthcare HMO Rider $0.13
Rate for Payer: United Healthcare Select/Navigate/Core $0.13
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.22
Rate for Payer: Vantage Medical Group Medi-Cal $0.22
Rate for Payer: Vantage Medical Group Senior $0.22
Service Code APR-DRG 8621
Min. Negotiated Rate $5,673.00
Max. Negotiated Rate $7,395.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $5,673.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal $7,395.33
Service Code APR-DRG 8624
Min. Negotiated Rate $9,699.87
Max. Negotiated Rate $12,644.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $9,699.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal $12,644.77
Service Code APR-DRG 8623
Min. Negotiated Rate $9,237.33
Max. Negotiated Rate $12,041.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $9,237.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal $12,041.80
Service Code APR-DRG 8622
Min. Negotiated Rate $8,267.33
Max. Negotiated Rate $10,777.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $8,267.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal $10,777.31
Service Code APR-DRG 2534
Min. Negotiated Rate $21,569.63
Max. Negotiated Rate $28,118.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $21,569.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal $28,118.21
Service Code APR-DRG 2533
Min. Negotiated Rate $12,521.40
Max. Negotiated Rate $16,322.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $12,521.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal $16,322.92
Service Code APR-DRG 2531
Min. Negotiated Rate $6,881.06
Max. Negotiated Rate $8,970.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $6,881.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal $8,970.17
Service Code APR-DRG 2532
Min. Negotiated Rate $8,891.77
Max. Negotiated Rate $11,591.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $8,891.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal $11,591.33
Service Code APR-DRG 6631
Min. Negotiated Rate $5,758.70
Max. Negotiated Rate $7,507.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $5,758.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal $7,507.05
Service Code APR-DRG 6634
Min. Negotiated Rate $18,801.15
Max. Negotiated Rate $24,509.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $18,801.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal $24,509.22