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Service Code NDC 68382-097-06
Hospital Charge Code 1713121
Hospital Revenue Code 259
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.12
Rate for Payer: Blue Shield of California Commercial $0.10
Rate for Payer: Blue Shield of California EPN $0.07
Rate for Payer: Cash Price $0.06
Rate for Payer: Cigna of CA HMO $0.10
Rate for Payer: Cigna of CA PPO $0.10
Rate for Payer: EPIC Health Plan Commercial $0.06
Rate for Payer: Galaxy Health WC $0.12
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 $0.11
Rate for Payer: Networks By Design Commercial $0.09
Rate for Payer: Prime Health Services Commercial $0.12
Service Code NDC 0904-5677-61
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.26
Rate for Payer: Blue Shield of California Commercial $0.21
Rate for Payer: Blue Shield of California EPN $0.15
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO $0.21
Rate for Payer: Cigna of CA PPO $0.21
Rate for Payer: EPIC Health Plan Commercial $0.12
Rate for Payer: Galaxy Health WC $0.26
Rate for Payer: Global Benefits Group Commercial $0.18
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.20
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 $0.24
Rate for Payer: Networks By Design Commercial $0.20
Rate for Payer: Prime Health Services Commercial $0.26
Service Code NDC 68382-098-06
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.14
Rate for Payer: Aetna of CA HMO/PPO $0.11
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 $0.13
Rate for Payer: Blue Shield of California EPN $0.10
Rate for Payer: Cash Price $0.08
Rate for Payer: Cigna of CA HMO $0.12
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 $0.07
Rate for Payer: EPIC Health Plan Transplant $0.07
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 $0.13
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 $0.14
Rate for Payer: Networks By Design Commercial $0.11
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 $0.09
Rate for Payer: United Healthcare All Other HMO $0.09
Rate for Payer: United Healthcare HMO Rider $0.09
Rate for Payer: United Healthcare Select/Navigate/Core $0.09
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 60505-0083-1
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.14
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 $0.08
Rate for Payer: Cigna of CA HMO $0.12
Rate for Payer: Cigna of CA PPO $0.12
Rate for Payer: EPIC Health Plan Commercial $0.07
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 $0.14
Rate for Payer: Networks By Design Commercial $0.11
Rate for Payer: Prime Health Services Commercial $0.14
Service Code NDC 68382-098-06
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.14
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 $0.08
Rate for Payer: Cigna of CA HMO $0.12
Rate for Payer: Cigna of CA PPO $0.12
Rate for Payer: EPIC Health Plan Commercial $0.07
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 $0.14
Rate for Payer: Networks By Design Commercial $0.11
Rate for Payer: Prime Health Services Commercial $0.14
Service Code NDC 68084-045-11
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.33
Rate for Payer: Blue Shield of California Commercial $0.28
Rate for Payer: Blue Shield of California EPN $0.20
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA HMO $0.27
Rate for Payer: Cigna of CA PPO $0.27
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: Galaxy Health WC $0.33
Rate for Payer: Global Benefits Group Commercial $0.23
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.15
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.31
Rate for Payer: Networks By Design Commercial $0.25
Rate for Payer: Prime Health Services Commercial $0.33
Service Code NDC 68084-045-01
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.33
Rate for Payer: Blue Shield of California Commercial $0.28
Rate for Payer: Blue Shield of California EPN $0.20
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA HMO $0.27
Rate for Payer: Cigna of CA PPO $0.27
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: Galaxy Health WC $0.33
Rate for Payer: Global Benefits Group Commercial $0.23
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.15
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.31
Rate for Payer: Networks By Design Commercial $0.25
Rate for Payer: Prime Health Services Commercial $0.33
Service Code NDC 68084-045-11
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.33
Rate for Payer: Aetna of CA HMO/PPO $0.26
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.33
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.21
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.23
Rate for Payer: Blue Distinction Transplant $0.23
Rate for Payer: Blue Shield of California Commercial $0.29
Rate for Payer: Blue Shield of California EPN $0.23
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA HMO $0.27
Rate for Payer: Cigna of CA PPO $0.27
Rate for Payer: Dignity Health Commercial/Exchange $0.33
Rate for Payer: Dignity Health Media $0.33
Rate for Payer: Dignity Health Medi-Cal $0.33
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: EPIC Health Plan Transplant $0.16
Rate for Payer: Galaxy Health WC $0.33
Rate for Payer: Global Benefits Group Commercial $0.23
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.29
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.15
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.31
Rate for Payer: Networks By Design Commercial $0.25
Rate for Payer: Prime Health Services Commercial $0.33
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.23
Rate for Payer: TriValley Medical Group Commercial/Senior $0.23
Rate for Payer: United Healthcare All Other Commercial $0.20
Rate for Payer: United Healthcare All Other HMO $0.20
Rate for Payer: United Healthcare HMO Rider $0.20
Rate for Payer: United Healthcare Select/Navigate/Core $0.20
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.33
Rate for Payer: Vantage Medical Group Medi-Cal $0.33
Rate for Payer: Vantage Medical Group Senior $0.33
Service Code NDC 68084-045-01
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.33
Rate for Payer: Aetna of CA HMO/PPO $0.26
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.33
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.21
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.23
Rate for Payer: Blue Distinction Transplant $0.23
Rate for Payer: Blue Shield of California Commercial $0.29
Rate for Payer: Blue Shield of California EPN $0.23
Rate for Payer: Cash Price $0.18
Rate for Payer: Cigna of CA HMO $0.27
Rate for Payer: Cigna of CA PPO $0.27
Rate for Payer: Dignity Health Commercial/Exchange $0.33
Rate for Payer: Dignity Health Media $0.33
Rate for Payer: Dignity Health Medi-Cal $0.33
Rate for Payer: EPIC Health Plan Commercial $0.16
Rate for Payer: EPIC Health Plan Transplant $0.16
Rate for Payer: Galaxy Health WC $0.33
Rate for Payer: Global Benefits Group Commercial $0.23
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.29
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.15
Rate for Payer: LLUH Dept of Risk Management WC $0.09
Rate for Payer: Multiplan Commercial $0.31
Rate for Payer: Networks By Design Commercial $0.25
Rate for Payer: Prime Health Services Commercial $0.33
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.23
Rate for Payer: TriValley Medical Group Commercial/Senior $0.23
Rate for Payer: United Healthcare All Other Commercial $0.20
Rate for Payer: United Healthcare All Other HMO $0.20
Rate for Payer: United Healthcare HMO Rider $0.20
Rate for Payer: United Healthcare Select/Navigate/Core $0.20
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.33
Rate for Payer: Vantage Medical Group Medi-Cal $0.33
Rate for Payer: Vantage Medical Group Senior $0.33
Service Code NDC 60505-0083-1
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.14
Rate for Payer: Aetna of CA HMO/PPO $0.11
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 $0.13
Rate for Payer: Blue Shield of California EPN $0.10
Rate for Payer: Cash Price $0.08
Rate for Payer: Cigna of CA HMO $0.12
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 $0.07
Rate for Payer: EPIC Health Plan Transplant $0.07
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 $0.13
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 $0.14
Rate for Payer: Networks By Design Commercial $0.11
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 $0.09
Rate for Payer: United Healthcare All Other HMO $0.09
Rate for Payer: United Healthcare HMO Rider $0.09
Rate for Payer: United Healthcare Select/Navigate/Core $0.09
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 0904-5677-61
Hospital Charge Code 1711583
Hospital Revenue Code 259
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.26
Rate for Payer: Aetna of CA HMO/PPO $0.20
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.26
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.17
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.17
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.18
Rate for Payer: Blue Distinction Transplant $0.18
Rate for Payer: Blue Shield of California Commercial $0.22
Rate for Payer: Blue Shield of California EPN $0.18
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO $0.21
Rate for Payer: Cigna of CA PPO $0.21
Rate for Payer: Dignity Health Commercial/Exchange $0.26
Rate for Payer: Dignity Health Media $0.26
Rate for Payer: Dignity Health Medi-Cal $0.26
Rate for Payer: EPIC Health Plan Commercial $0.12
Rate for Payer: EPIC Health Plan Transplant $0.12
Rate for Payer: Galaxy Health WC $0.26
Rate for Payer: Global Benefits Group Commercial $0.18
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.23
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.20
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 $0.24
Rate for Payer: Networks By Design Commercial $0.20
Rate for Payer: Prime Health Services Commercial $0.26
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.18
Rate for Payer: TriValley Medical Group Commercial/Senior $0.18
Rate for Payer: United Healthcare All Other Commercial $0.15
Rate for Payer: United Healthcare All Other HMO $0.15
Rate for Payer: United Healthcare HMO Rider $0.15
Rate for Payer: United Healthcare Select/Navigate/Core $0.15
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.26
Rate for Payer: Vantage Medical Group Medi-Cal $0.26
Rate for Payer: Vantage Medical Group Senior $0.26
Service Code NDC 43547-349-03
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.27
Rate for Payer: Blue Shield of California Commercial $0.23
Rate for Payer: Blue Shield of California EPN $0.16
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO $0.22
Rate for Payer: Cigna of CA PPO $0.22
Rate for Payer: EPIC Health Plan Commercial $0.13
Rate for Payer: Galaxy Health WC $0.27
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 $0.08
Rate for Payer: Multiplan Commercial $0.26
Rate for Payer: Networks By Design Commercial $0.21
Rate for Payer: Prime Health Services Commercial $0.27
Service Code NDC 68084-046-11
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.27
Max. Negotiated Rate $0.97
Rate for Payer: Blue Shield of California Commercial $0.81
Rate for Payer: Blue Shield of California EPN $0.58
Rate for Payer: Cash Price $0.51
Rate for Payer: Cigna of CA HMO $0.80
Rate for Payer: Cigna of CA PPO $0.80
Rate for Payer: EPIC Health Plan Commercial $0.46
Rate for Payer: Galaxy Health WC $0.97
Rate for Payer: Global Benefits Group Commercial $0.68
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.43
Rate for Payer: LLUH Dept of Risk Management WC $0.27
Rate for Payer: Multiplan Commercial $0.91
Rate for Payer: Networks By Design Commercial $0.74
Rate for Payer: Prime Health Services Commercial $0.97
Service Code NDC 50268-642-15
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.47
Rate for Payer: Blue Shield of California Commercial $0.39
Rate for Payer: Blue Shield of California EPN $0.28
Rate for Payer: Cash Price $0.25
Rate for Payer: Cigna of CA HMO $0.39
Rate for Payer: Cigna of CA PPO $0.39
Rate for Payer: EPIC Health Plan Commercial $0.22
Rate for Payer: Galaxy Health WC $0.47
Rate for Payer: Global Benefits Group Commercial $0.33
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.21
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.44
Rate for Payer: Networks By Design Commercial $0.36
Rate for Payer: Prime Health Services Commercial $0.47
Service Code NDC 68084-046-11
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.27
Max. Negotiated Rate $0.97
Rate for Payer: Aetna of CA HMO/PPO $0.75
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.97
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.63
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.63
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.68
Rate for Payer: Blue Distinction Transplant $0.68
Rate for Payer: Blue Shield of California Commercial $0.84
Rate for Payer: Blue Shield of California EPN $0.67
Rate for Payer: Cash Price $0.51
Rate for Payer: Cigna of CA HMO $0.80
Rate for Payer: Cigna of CA PPO $0.80
Rate for Payer: Dignity Health Commercial/Exchange $0.97
Rate for Payer: Dignity Health Media $0.97
Rate for Payer: Dignity Health Medi-Cal $0.97
Rate for Payer: EPIC Health Plan Commercial $0.46
Rate for Payer: EPIC Health Plan Transplant $0.46
Rate for Payer: Galaxy Health WC $0.97
Rate for Payer: Global Benefits Group Commercial $0.68
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.86
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.43
Rate for Payer: LLUH Dept of Risk Management WC $0.27
Rate for Payer: Multiplan Commercial $0.91
Rate for Payer: Networks By Design Commercial $0.74
Rate for Payer: Prime Health Services Commercial $0.97
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.68
Rate for Payer: TriValley Medical Group Commercial/Senior $0.68
Rate for Payer: United Healthcare All Other Commercial $0.57
Rate for Payer: United Healthcare All Other HMO $0.57
Rate for Payer: United Healthcare HMO Rider $0.57
Rate for Payer: United Healthcare Select/Navigate/Core $0.57
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.97
Rate for Payer: Vantage Medical Group Medi-Cal $0.97
Rate for Payer: Vantage Medical Group Senior $0.97
Service Code NDC 43547-349-03
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.27
Rate for Payer: Aetna of CA HMO/PPO $0.21
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.27
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.18
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.18
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.19
Rate for Payer: Blue Distinction Transplant $0.19
Rate for Payer: Blue Shield of California Commercial $0.24
Rate for Payer: Blue Shield of California EPN $0.19
Rate for Payer: Cash Price $0.14
Rate for Payer: Cigna of CA HMO $0.22
Rate for Payer: Cigna of CA PPO $0.22
Rate for Payer: Dignity Health Commercial/Exchange $0.27
Rate for Payer: Dignity Health Media $0.27
Rate for Payer: Dignity Health Medi-Cal $0.27
Rate for Payer: EPIC Health Plan Commercial $0.13
Rate for Payer: EPIC Health Plan Transplant $0.13
Rate for Payer: Galaxy Health WC $0.27
Rate for Payer: Global Benefits Group Commercial $0.19
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.24
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 $0.08
Rate for Payer: Multiplan Commercial $0.26
Rate for Payer: Networks By Design Commercial $0.21
Rate for Payer: Prime Health Services Commercial $0.27
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.19
Rate for Payer: TriValley Medical Group Commercial/Senior $0.19
Rate for Payer: United Healthcare All Other Commercial $0.16
Rate for Payer: United Healthcare All Other HMO $0.16
Rate for Payer: United Healthcare HMO Rider $0.16
Rate for Payer: United Healthcare Select/Navigate/Core $0.16
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.27
Rate for Payer: Vantage Medical Group Medi-Cal $0.27
Rate for Payer: Vantage Medical Group Senior $0.27
Service Code NDC 68382-099-06
Hospital Charge Code 1713111
Hospital Revenue Code 259
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: Cigna of CA HMO $0.16
Rate for Payer: Cigna of CA PPO $0.16
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 68382-099-06
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of CA HMO/PPO $0.15
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 $0.17
Rate for Payer: Blue Shield of California EPN $0.13
Rate for Payer: Cash Price $0.10
Rate for Payer: Cigna of CA HMO $0.16
Rate for Payer: Cigna of CA PPO $0.16
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 $0.09
Rate for Payer: EPIC Health Plan Transplant $0.09
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 $0.17
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
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 50268-642-11
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.47
Rate for Payer: Blue Shield of California Commercial $0.39
Rate for Payer: Blue Shield of California EPN $0.28
Rate for Payer: Cash Price $0.25
Rate for Payer: Cigna of CA HMO $0.39
Rate for Payer: Cigna of CA PPO $0.39
Rate for Payer: EPIC Health Plan Commercial $0.22
Rate for Payer: Galaxy Health WC $0.47
Rate for Payer: Global Benefits Group Commercial $0.33
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.21
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.44
Rate for Payer: Networks By Design Commercial $0.36
Rate for Payer: Prime Health Services Commercial $0.47
Service Code NDC 50268-642-15
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.47
Rate for Payer: Aetna of CA HMO/PPO $0.36
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.47
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.30
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.30
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.33
Rate for Payer: Blue Distinction Transplant $0.33
Rate for Payer: Blue Shield of California Commercial $0.41
Rate for Payer: Blue Shield of California EPN $0.32
Rate for Payer: Cash Price $0.25
Rate for Payer: Cigna of CA HMO $0.39
Rate for Payer: Cigna of CA PPO $0.39
Rate for Payer: Dignity Health Commercial/Exchange $0.47
Rate for Payer: Dignity Health Media $0.47
Rate for Payer: Dignity Health Medi-Cal $0.47
Rate for Payer: EPIC Health Plan Commercial $0.22
Rate for Payer: EPIC Health Plan Transplant $0.22
Rate for Payer: Galaxy Health WC $0.47
Rate for Payer: Global Benefits Group Commercial $0.33
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.41
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.21
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.44
Rate for Payer: Networks By Design Commercial $0.36
Rate for Payer: Prime Health Services Commercial $0.47
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.33
Rate for Payer: TriValley Medical Group Commercial/Senior $0.33
Rate for Payer: United Healthcare All Other Commercial $0.28
Rate for Payer: United Healthcare All Other HMO $0.28
Rate for Payer: United Healthcare HMO Rider $0.28
Rate for Payer: United Healthcare Select/Navigate/Core $0.28
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.47
Rate for Payer: Vantage Medical Group Medi-Cal $0.47
Rate for Payer: Vantage Medical Group Senior $0.47
Service Code NDC 50268-642-11
Hospital Charge Code 1713111
Hospital Revenue Code 259
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.47
Rate for Payer: Aetna of CA HMO/PPO $0.36
Rate for Payer: Alpha Care Medical Group Commercial/Exchange $0.47
Rate for Payer: Alpha Care Medical Group Medi-Cal $0.30
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product $0.30
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $0.33
Rate for Payer: Blue Distinction Transplant $0.33
Rate for Payer: Blue Shield of California Commercial $0.41
Rate for Payer: Blue Shield of California EPN $0.32
Rate for Payer: Cash Price $0.25
Rate for Payer: Cigna of CA HMO $0.39
Rate for Payer: Cigna of CA PPO $0.39
Rate for Payer: Dignity Health Commercial/Exchange $0.47
Rate for Payer: Dignity Health Media $0.47
Rate for Payer: Dignity Health Medi-Cal $0.47
Rate for Payer: EPIC Health Plan Commercial $0.22
Rate for Payer: EPIC Health Plan Transplant $0.22
Rate for Payer: Galaxy Health WC $0.47
Rate for Payer: Global Benefits Group Commercial $0.33
Rate for Payer: Health Plan of Nevada (Sierra) Other $0.41
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal $0.21
Rate for Payer: LLUH Dept of Risk Management WC $0.13
Rate for Payer: Multiplan Commercial $0.44
Rate for Payer: Networks By Design Commercial $0.36
Rate for Payer: Prime Health Services Commercial $0.47
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $0.33
Rate for Payer: TriValley Medical Group Commercial/Senior $0.33
Rate for Payer: United Healthcare All Other Commercial $0.28
Rate for Payer: United Healthcare All Other HMO $0.28
Rate for Payer: United Healthcare HMO Rider $0.28
Rate for Payer: United Healthcare Select/Navigate/Core $0.28
Rate for Payer: Vantage Medical Group Commercial/Exchange $0.47
Rate for Payer: Vantage Medical Group Medi-Cal $0.47
Rate for Payer: Vantage Medical Group Senior $0.47
Service Code APR-DRG 8443
Min. Negotiated Rate $12,186.74
Max. Negotiated Rate $15,886.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $12,186.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal $15,886.66
Service Code APR-DRG 8442
Min. Negotiated Rate $7,090.56
Max. Negotiated Rate $9,243.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $7,090.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal $9,243.27
Service Code APR-DRG 8441
Min. Negotiated Rate $4,376.51
Max. Negotiated Rate $5,705.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $4,376.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal $5,705.22
Service Code APR-DRG 8444
Min. Negotiated Rate $28,144.59
Max. Negotiated Rate $36,689.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $28,144.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal $36,689.34