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Service Code NDC 57894-502-20
Hospital Charge Code NDG211862
Hospital Revenue Code 636
Min. Negotiated Rate $32.11
Max. Negotiated Rate $144.50
Rate for Payer: Blue Shield of California Commercial $120.42
Rate for Payer: Blue Shield of California EPN $85.74
Rate for Payer: Cash Price $72.25
Rate for Payer: Central Health Plan Commercial $128.45
Rate for Payer: Cigna of CA HMO $112.39
Rate for Payer: Cigna of CA PPO $112.39
Rate for Payer: EPIC Health Plan Commercial $64.22
Rate for Payer: EPIC Health Plan Transplant $64.22
Rate for Payer: Galaxy Health WC $136.48
Rate for Payer: Global Benefits Group Commercial $96.34
Rate for Payer: Health Management Network EPO/PPO $144.50
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $107.09
Rate for Payer: LLUH Dept of Risk Management WC $32.11
Rate for Payer: Multiplan Commercial $120.42
Rate for Payer: Networks By Design Commercial $80.28
Rate for Payer: Prime Health Services Commercial $136.48
Service Code NDC 57894-502-05
Hospital Charge Code NDG211862B
Hospital Revenue Code 636
Min. Negotiated Rate $32.11
Max. Negotiated Rate $144.50
Rate for Payer: Blue Shield of California Commercial $120.42
Rate for Payer: Blue Shield of California EPN $85.74
Rate for Payer: Cash Price $72.25
Rate for Payer: Central Health Plan Commercial $128.45
Rate for Payer: Cigna of CA HMO $112.39
Rate for Payer: Cigna of CA PPO $112.39
Rate for Payer: EPIC Health Plan Commercial $64.22
Rate for Payer: EPIC Health Plan Transplant $64.22
Rate for Payer: Galaxy Health WC $136.48
Rate for Payer: Global Benefits Group Commercial $96.34
Rate for Payer: Health Management Network EPO/PPO $144.50
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $107.09
Rate for Payer: LLUH Dept of Risk Management WC $32.11
Rate for Payer: Multiplan Commercial $120.42
Rate for Payer: Networks By Design Commercial $80.28
Rate for Payer: Prime Health Services Commercial $136.48
Service Code NDC 57894-502-05
Hospital Charge Code NDG211862B
Hospital Revenue Code 636
Min. Negotiated Rate $32.11
Max. Negotiated Rate $144.50
Rate for Payer: Aetna of CA HMO/PPO $97.51
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $136.48
Rate for Payer: AlphaCare Medical Group Medi-Cal $88.31
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $88.31
Rate for Payer: Anthem Blue Cross of CA Exchange $77.74
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $94.86
Rate for Payer: BCBS Transplant Transplant $96.34
Rate for Payer: Blue Shield of California Commercial $100.99
Rate for Payer: Blue Shield of California EPN $78.51
Rate for Payer: Cash Price $72.25
Rate for Payer: Cash Price $72.25
Rate for Payer: Central Health Plan Commercial $128.45
Rate for Payer: Cigna of CA HMO $112.39
Rate for Payer: Cigna of CA PPO $112.39
Rate for Payer: Dignity Health Commercial/Exchange $136.48
Rate for Payer: EPIC Health Plan Commercial $64.22
Rate for Payer: EPIC Health Plan Transplant $64.22
Rate for Payer: Galaxy Health WC $136.48
Rate for Payer: Global Benefits Group Commercial $96.34
Rate for Payer: Health Management Network EPO/PPO $144.50
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $120.42
Rate for Payer: IEHP medi-cal $56.20
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $107.09
Rate for Payer: LLUH Dept of Risk Management WC $32.11
Rate for Payer: Multiplan Commercial $120.42
Rate for Payer: Networks By Design Commercial $80.28
Rate for Payer: Prime Health Services Commercial $136.48
Rate for Payer: Riverside University Health MISP $64.22
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $96.34
Rate for Payer: TriValley Medical Group Commercial/Senior $96.34
Rate for Payer: United Healthcare All Other Commercial $80.28
Rate for Payer: United Healthcare All Other HMO $80.28
Rate for Payer: United Healthcare HMO Rider $80.28
Rate for Payer: United Healthcare Select/Navigate/Core $80.28
Rate for Payer: Vantage Medical Group Medi-Cal $136.48
Rate for Payer: Vantage Medical Group Senior $136.48
Service Code CPT J9144
Hospital Charge Code NDG228045
Hospital Revenue Code 636
Min. Negotiated Rate $145.90
Max. Negotiated Rate $656.54
Rate for Payer: Blue Shield of California Commercial $547.12
Rate for Payer: Blue Shield of California EPN $389.55
Rate for Payer: Cash Price $328.27
Rate for Payer: Central Health Plan Commercial $583.59
Rate for Payer: Cigna of CA HMO $510.64
Rate for Payer: Cigna of CA PPO $510.64
Rate for Payer: EPIC Health Plan Commercial $291.80
Rate for Payer: EPIC Health Plan Transplant $291.80
Rate for Payer: Galaxy Health WC $620.07
Rate for Payer: Global Benefits Group Commercial $437.69
Rate for Payer: Health Management Network EPO/PPO $656.54
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $486.57
Rate for Payer: LLUH Dept of Risk Management WC $145.90
Rate for Payer: Multiplan Commercial $547.12
Rate for Payer: Networks By Design Commercial $364.74
Rate for Payer: Prime Health Services Commercial $620.07
Service Code CPT J9144
Hospital Charge Code NDG228045
Hospital Revenue Code 636
Min. Negotiated Rate $49.05
Max. Negotiated Rate $656.54
Rate for Payer: Adventist Health Medi-Cal $49.05
Rate for Payer: Aetna of CA HMO/PPO $96.60
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $61.31
Rate for Payer: AlphaCare Medical Group Medi-Cal $53.96
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $53.96
Rate for Payer: Anthem Blue Cross of CA Exchange $83.25
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $91.15
Rate for Payer: BCBS Transplant Transplant $437.69
Rate for Payer: Blue Shield of California Commercial $458.85
Rate for Payer: Blue Shield of California EPN $356.72
Rate for Payer: Caremore Medicare Advantage $49.05
Rate for Payer: Cash Price $328.27
Rate for Payer: Cash Price $328.27
Rate for Payer: Central Health Plan Commercial $583.59
Rate for Payer: Cigna of CA HMO $510.64
Rate for Payer: Cigna of CA PPO $510.64
Rate for Payer: Dignity Health Commercial/Exchange $61.31
Rate for Payer: EPIC Health Plan Commercial $66.22
Rate for Payer: EPIC Health Plan Medicare/Senior $49.05
Rate for Payer: EPIC Health Plan Transplant $49.05
Rate for Payer: Galaxy Health WC $620.07
Rate for Payer: Global Benefits Group Commercial $437.69
Rate for Payer: Health Management Network EPO/PPO $656.54
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $547.12
Rate for Payer: Heritage Provider Network Commercial/Senior $80.44
Rate for Payer: IEHP medi-cal $80.93
Rate for Payer: IEHP Medicare Advantage $49.05
Rate for Payer: Innovage PACE Commercial $73.58
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $486.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $49.05
Rate for Payer: LLUH Dept of Risk Management WC $145.90
Rate for Payer: Molina Healthcare of CA Medi-Cal $65.73
Rate for Payer: Molina Healthcare of CA Medicare $65.73
Rate for Payer: Multiplan Commercial $547.12
Rate for Payer: Networks By Design Commercial $364.74
Rate for Payer: Prime Health Services Commercial $620.07
Rate for Payer: Prime Health Services Medicare $51.99
Rate for Payer: Riverside University Health MISP $53.96
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $437.69
Rate for Payer: TriValley Medical Group Commercial/Senior $437.69
Rate for Payer: United Healthcare All Other Commercial $364.74
Rate for Payer: United Healthcare All Other HMO $364.74
Rate for Payer: United Healthcare HMO Rider $364.74
Rate for Payer: United Healthcare Select/Navigate/Core $364.74
Rate for Payer: Vantage Medical Group Commercial/Exchange $61.31
Rate for Payer: Vantage Medical Group Medi-Cal $53.96
Rate for Payer: Vantage Medical Group Senior $53.96
Service Code CPT J0881
Hospital Charge Code 1720972
Hospital Revenue Code 636
Min. Negotiated Rate $371.52
Max. Negotiated Rate $1,671.84
Rate for Payer: Blue Shield of California Commercial $1,393.20
Rate for Payer: Blue Shield of California EPN $991.96
Rate for Payer: Cash Price $835.92
Rate for Payer: Central Health Plan Commercial $1,486.08
Rate for Payer: Cigna of CA HMO $1,300.32
Rate for Payer: Cigna of CA PPO $1,300.32
Rate for Payer: EPIC Health Plan Commercial $743.04
Rate for Payer: EPIC Health Plan Transplant $743.04
Rate for Payer: Galaxy Health WC $1,578.96
Rate for Payer: Global Benefits Group Commercial $1,114.56
Rate for Payer: Health Management Network EPO/PPO $1,671.84
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1,239.02
Rate for Payer: LLUH Dept of Risk Management WC $371.52
Rate for Payer: Multiplan Commercial $1,393.20
Rate for Payer: Networks By Design Commercial $928.80
Rate for Payer: Prime Health Services Commercial $1,578.96
Service Code CPT J0881
Hospital Charge Code 1720972
Hospital Revenue Code 636
Min. Negotiated Rate $2.93
Max. Negotiated Rate $1,671.84
Rate for Payer: Adventist Health Medi-Cal $2.93
Rate for Payer: Aetna of CA HMO/PPO $5.77
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $3.66
Rate for Payer: AlphaCare Medical Group Medi-Cal $3.22
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $3.22
Rate for Payer: Anthem Blue Cross of CA Exchange $57.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $63.20
Rate for Payer: BCBS Transplant Transplant $1,114.56
Rate for Payer: Blue Shield of California Commercial $10.22
Rate for Payer: Blue Shield of California EPN $9.29
Rate for Payer: Caremore Medicare Advantage $2.93
Rate for Payer: Cash Price $835.92
Rate for Payer: Cash Price $835.92
Rate for Payer: Central Health Plan Commercial $1,486.08
Rate for Payer: Cigna of CA HMO $1,300.32
Rate for Payer: Cigna of CA PPO $1,300.32
Rate for Payer: Dignity Health Commercial/Exchange $4.40
Rate for Payer: EPIC Health Plan Commercial $3.96
Rate for Payer: EPIC Health Plan Medicare/Senior $2.93
Rate for Payer: EPIC Health Plan Transplant $2.93
Rate for Payer: Galaxy Health WC $1,578.96
Rate for Payer: Global Benefits Group Commercial $1,114.56
Rate for Payer: Health Management Network EPO/PPO $1,671.84
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $1,393.20
Rate for Payer: Heritage Provider Network Commercial/Senior $4.81
Rate for Payer: IEHP medi-cal $4.83
Rate for Payer: IEHP Medicare Advantage $2.93
Rate for Payer: Innovage PACE Commercial $4.40
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1,239.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $2.93
Rate for Payer: LLUH Dept of Risk Management WC $371.52
Rate for Payer: Molina Healthcare of CA Medi-Cal $3.93
Rate for Payer: Molina Healthcare of CA Medicare $3.93
Rate for Payer: Multiplan Commercial $1,393.20
Rate for Payer: Networks By Design Commercial $928.80
Rate for Payer: Prime Health Services Commercial $1,578.96
Rate for Payer: Prime Health Services Medicare $3.11
Rate for Payer: Riverside University Health MISP $3.22
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $1,114.56
Rate for Payer: TriValley Medical Group Commercial/Senior $1,114.56
Rate for Payer: United Healthcare All Other Commercial $928.80
Rate for Payer: United Healthcare All Other HMO $928.80
Rate for Payer: United Healthcare HMO Rider $928.80
Rate for Payer: United Healthcare Select/Navigate/Core $928.80
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.40
Rate for Payer: Vantage Medical Group Medi-Cal $3.22
Rate for Payer: Vantage Medical Group Senior $2.93
Service Code CPT J0881
Hospital Charge Code 1720973
Hospital Revenue Code 636
Min. Negotiated Rate $2.93
Max. Negotiated Rate $4,179.60
Rate for Payer: Adventist Health Medi-Cal $2.93
Rate for Payer: Aetna of CA HMO/PPO $5.77
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $3.66
Rate for Payer: AlphaCare Medical Group Medi-Cal $3.22
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $3.22
Rate for Payer: Anthem Blue Cross of CA Exchange $57.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $63.20
Rate for Payer: BCBS Transplant Transplant $2,786.40
Rate for Payer: Blue Shield of California Commercial $10.22
Rate for Payer: Blue Shield of California EPN $9.29
Rate for Payer: Caremore Medicare Advantage $2.93
Rate for Payer: Cash Price $2,089.80
Rate for Payer: Cash Price $2,089.80
Rate for Payer: Central Health Plan Commercial $3,715.20
Rate for Payer: Cigna of CA HMO $3,250.80
Rate for Payer: Cigna of CA PPO $3,250.80
Rate for Payer: Dignity Health Commercial/Exchange $4.40
Rate for Payer: EPIC Health Plan Commercial $3.96
Rate for Payer: EPIC Health Plan Medicare/Senior $2.93
Rate for Payer: EPIC Health Plan Transplant $2.93
Rate for Payer: Galaxy Health WC $3,947.40
Rate for Payer: Global Benefits Group Commercial $2,786.40
Rate for Payer: Health Management Network EPO/PPO $4,179.60
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $3,483.00
Rate for Payer: Heritage Provider Network Commercial/Senior $4.81
Rate for Payer: IEHP medi-cal $4.83
Rate for Payer: IEHP Medicare Advantage $2.93
Rate for Payer: Innovage PACE Commercial $4.40
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $3,097.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $2.93
Rate for Payer: LLUH Dept of Risk Management WC $928.80
Rate for Payer: Molina Healthcare of CA Medi-Cal $3.93
Rate for Payer: Molina Healthcare of CA Medicare $3.93
Rate for Payer: Multiplan Commercial $3,483.00
Rate for Payer: Networks By Design Commercial $2,322.00
Rate for Payer: Prime Health Services Commercial $3,947.40
Rate for Payer: Prime Health Services Medicare $3.11
Rate for Payer: Riverside University Health MISP $3.22
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $2,786.40
Rate for Payer: TriValley Medical Group Commercial/Senior $2,786.40
Rate for Payer: United Healthcare All Other Commercial $2,322.00
Rate for Payer: United Healthcare All Other HMO $2,322.00
Rate for Payer: United Healthcare HMO Rider $2,322.00
Rate for Payer: United Healthcare Select/Navigate/Core $2,322.00
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.40
Rate for Payer: Vantage Medical Group Medi-Cal $3.22
Rate for Payer: Vantage Medical Group Senior $2.93
Service Code CPT J0881
Hospital Charge Code 1720973
Hospital Revenue Code 636
Min. Negotiated Rate $928.80
Max. Negotiated Rate $4,179.60
Rate for Payer: Blue Shield of California Commercial $3,483.00
Rate for Payer: Blue Shield of California EPN $2,479.90
Rate for Payer: Cash Price $2,089.80
Rate for Payer: Central Health Plan Commercial $3,715.20
Rate for Payer: Cigna of CA HMO $3,250.80
Rate for Payer: Cigna of CA PPO $3,250.80
Rate for Payer: EPIC Health Plan Commercial $1,857.60
Rate for Payer: EPIC Health Plan Transplant $1,857.60
Rate for Payer: Galaxy Health WC $3,947.40
Rate for Payer: Global Benefits Group Commercial $2,786.40
Rate for Payer: Health Management Network EPO/PPO $4,179.60
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $3,097.55
Rate for Payer: LLUH Dept of Risk Management WC $928.80
Rate for Payer: Multiplan Commercial $3,483.00
Rate for Payer: Networks By Design Commercial $2,322.00
Rate for Payer: Prime Health Services Commercial $3,947.40
Service Code CPT J0881
Hospital Charge Code 1720969
Hospital Revenue Code 636
Min. Negotiated Rate $110.57
Max. Negotiated Rate $497.57
Rate for Payer: Blue Shield of California Commercial $414.64
Rate for Payer: Blue Shield of California EPN $295.23
Rate for Payer: Cash Price $248.79
Rate for Payer: Central Health Plan Commercial $442.29
Rate for Payer: Cigna of CA HMO $387.00
Rate for Payer: Cigna of CA PPO $387.00
Rate for Payer: EPIC Health Plan Commercial $221.14
Rate for Payer: EPIC Health Plan Transplant $221.14
Rate for Payer: Galaxy Health WC $469.93
Rate for Payer: Global Benefits Group Commercial $331.72
Rate for Payer: Health Management Network EPO/PPO $497.57
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $368.76
Rate for Payer: LLUH Dept of Risk Management WC $110.57
Rate for Payer: Multiplan Commercial $414.64
Rate for Payer: Networks By Design Commercial $276.43
Rate for Payer: Prime Health Services Commercial $469.93
Service Code CPT J0881
Hospital Charge Code 1720969
Hospital Revenue Code 636
Min. Negotiated Rate $2.93
Max. Negotiated Rate $497.57
Rate for Payer: Adventist Health Medi-Cal $2.93
Rate for Payer: Aetna of CA HMO/PPO $5.77
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $3.66
Rate for Payer: AlphaCare Medical Group Medi-Cal $3.22
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $3.22
Rate for Payer: Anthem Blue Cross of CA Exchange $57.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $63.20
Rate for Payer: BCBS Transplant Transplant $331.72
Rate for Payer: Blue Shield of California Commercial $10.22
Rate for Payer: Blue Shield of California EPN $9.29
Rate for Payer: Caremore Medicare Advantage $2.93
Rate for Payer: Cash Price $248.79
Rate for Payer: Cash Price $248.79
Rate for Payer: Central Health Plan Commercial $442.29
Rate for Payer: Cigna of CA HMO $387.00
Rate for Payer: Cigna of CA PPO $387.00
Rate for Payer: Dignity Health Commercial/Exchange $4.40
Rate for Payer: EPIC Health Plan Commercial $3.96
Rate for Payer: EPIC Health Plan Medicare/Senior $2.93
Rate for Payer: EPIC Health Plan Transplant $2.93
Rate for Payer: Galaxy Health WC $469.93
Rate for Payer: Global Benefits Group Commercial $331.72
Rate for Payer: Health Management Network EPO/PPO $497.57
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $414.64
Rate for Payer: Heritage Provider Network Commercial/Senior $4.81
Rate for Payer: IEHP medi-cal $4.83
Rate for Payer: IEHP Medicare Advantage $2.93
Rate for Payer: Innovage PACE Commercial $4.40
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $368.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $2.93
Rate for Payer: LLUH Dept of Risk Management WC $110.57
Rate for Payer: Molina Healthcare of CA Medi-Cal $3.93
Rate for Payer: Molina Healthcare of CA Medicare $3.93
Rate for Payer: Multiplan Commercial $414.64
Rate for Payer: Networks By Design Commercial $276.43
Rate for Payer: Prime Health Services Commercial $469.93
Rate for Payer: Prime Health Services Medicare $3.11
Rate for Payer: Riverside University Health MISP $3.22
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $331.72
Rate for Payer: TriValley Medical Group Commercial/Senior $331.72
Rate for Payer: United Healthcare All Other Commercial $276.43
Rate for Payer: United Healthcare All Other HMO $276.43
Rate for Payer: United Healthcare HMO Rider $276.43
Rate for Payer: United Healthcare Select/Navigate/Core $276.43
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.40
Rate for Payer: Vantage Medical Group Medi-Cal $3.22
Rate for Payer: Vantage Medical Group Senior $2.93
Service Code CPT J0881
Hospital Charge Code 1720970
Hospital Revenue Code 636
Min. Negotiated Rate $185.76
Max. Negotiated Rate $835.92
Rate for Payer: Blue Shield of California Commercial $696.60
Rate for Payer: Blue Shield of California EPN $495.98
Rate for Payer: Cash Price $417.96
Rate for Payer: Central Health Plan Commercial $743.04
Rate for Payer: Cigna of CA HMO $650.16
Rate for Payer: Cigna of CA PPO $650.16
Rate for Payer: EPIC Health Plan Commercial $371.52
Rate for Payer: EPIC Health Plan Transplant $371.52
Rate for Payer: Galaxy Health WC $789.48
Rate for Payer: Global Benefits Group Commercial $557.28
Rate for Payer: Health Management Network EPO/PPO $835.92
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $619.51
Rate for Payer: LLUH Dept of Risk Management WC $185.76
Rate for Payer: Multiplan Commercial $696.60
Rate for Payer: Networks By Design Commercial $464.40
Rate for Payer: Prime Health Services Commercial $789.48
Service Code CPT J0881
Hospital Charge Code 1720970
Hospital Revenue Code 636
Min. Negotiated Rate $2.93
Max. Negotiated Rate $835.92
Rate for Payer: Adventist Health Medi-Cal $2.93
Rate for Payer: Aetna of CA HMO/PPO $5.77
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $3.66
Rate for Payer: AlphaCare Medical Group Medi-Cal $3.22
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $3.22
Rate for Payer: Anthem Blue Cross of CA Exchange $57.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $63.20
Rate for Payer: BCBS Transplant Transplant $557.28
Rate for Payer: Blue Shield of California Commercial $10.22
Rate for Payer: Blue Shield of California EPN $9.29
Rate for Payer: Caremore Medicare Advantage $2.93
Rate for Payer: Cash Price $417.96
Rate for Payer: Cash Price $417.96
Rate for Payer: Central Health Plan Commercial $743.04
Rate for Payer: Cigna of CA HMO $650.16
Rate for Payer: Cigna of CA PPO $650.16
Rate for Payer: Dignity Health Commercial/Exchange $4.40
Rate for Payer: EPIC Health Plan Commercial $3.96
Rate for Payer: EPIC Health Plan Medicare/Senior $2.93
Rate for Payer: EPIC Health Plan Transplant $2.93
Rate for Payer: Galaxy Health WC $789.48
Rate for Payer: Global Benefits Group Commercial $557.28
Rate for Payer: Health Management Network EPO/PPO $835.92
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $696.60
Rate for Payer: Heritage Provider Network Commercial/Senior $4.81
Rate for Payer: IEHP medi-cal $4.83
Rate for Payer: IEHP Medicare Advantage $2.93
Rate for Payer: Innovage PACE Commercial $4.40
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $619.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $2.93
Rate for Payer: LLUH Dept of Risk Management WC $185.76
Rate for Payer: Molina Healthcare of CA Medi-Cal $3.93
Rate for Payer: Molina Healthcare of CA Medicare $3.93
Rate for Payer: Multiplan Commercial $696.60
Rate for Payer: Networks By Design Commercial $464.40
Rate for Payer: Prime Health Services Commercial $789.48
Rate for Payer: Prime Health Services Medicare $3.11
Rate for Payer: Riverside University Health MISP $3.22
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $557.28
Rate for Payer: TriValley Medical Group Commercial/Senior $557.28
Rate for Payer: United Healthcare All Other Commercial $464.40
Rate for Payer: United Healthcare All Other HMO $464.40
Rate for Payer: United Healthcare HMO Rider $464.40
Rate for Payer: United Healthcare Select/Navigate/Core $464.40
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.40
Rate for Payer: Vantage Medical Group Medi-Cal $3.22
Rate for Payer: Vantage Medical Group Senior $2.93
Service Code CPT J0881
Hospital Charge Code 1720971
Hospital Revenue Code 636
Min. Negotiated Rate $371.52
Max. Negotiated Rate $1,671.84
Rate for Payer: Blue Shield of California Commercial $1,393.20
Rate for Payer: Blue Shield of California EPN $991.96
Rate for Payer: Cash Price $835.92
Rate for Payer: Central Health Plan Commercial $1,486.08
Rate for Payer: Cigna of CA HMO $1,300.32
Rate for Payer: Cigna of CA PPO $1,300.32
Rate for Payer: EPIC Health Plan Commercial $743.04
Rate for Payer: EPIC Health Plan Transplant $743.04
Rate for Payer: Galaxy Health WC $1,578.96
Rate for Payer: Global Benefits Group Commercial $1,114.56
Rate for Payer: Health Management Network EPO/PPO $1,671.84
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1,239.02
Rate for Payer: LLUH Dept of Risk Management WC $371.52
Rate for Payer: Multiplan Commercial $1,393.20
Rate for Payer: Networks By Design Commercial $928.80
Rate for Payer: Prime Health Services Commercial $1,578.96
Service Code CPT J0881
Hospital Charge Code 1720971
Hospital Revenue Code 636
Min. Negotiated Rate $2.93
Max. Negotiated Rate $1,671.84
Rate for Payer: Adventist Health Medi-Cal $2.93
Rate for Payer: Aetna of CA HMO/PPO $5.77
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $3.66
Rate for Payer: AlphaCare Medical Group Medi-Cal $3.22
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $3.22
Rate for Payer: Anthem Blue Cross of CA Exchange $57.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $63.20
Rate for Payer: BCBS Transplant Transplant $1,114.56
Rate for Payer: Blue Shield of California Commercial $10.22
Rate for Payer: Blue Shield of California EPN $9.29
Rate for Payer: Caremore Medicare Advantage $2.93
Rate for Payer: Cash Price $835.92
Rate for Payer: Cash Price $835.92
Rate for Payer: Central Health Plan Commercial $1,486.08
Rate for Payer: Cigna of CA HMO $1,300.32
Rate for Payer: Cigna of CA PPO $1,300.32
Rate for Payer: Dignity Health Commercial/Exchange $4.40
Rate for Payer: EPIC Health Plan Commercial $3.96
Rate for Payer: EPIC Health Plan Medicare/Senior $2.93
Rate for Payer: EPIC Health Plan Transplant $2.93
Rate for Payer: Galaxy Health WC $1,578.96
Rate for Payer: Global Benefits Group Commercial $1,114.56
Rate for Payer: Health Management Network EPO/PPO $1,671.84
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $1,393.20
Rate for Payer: Heritage Provider Network Commercial/Senior $4.81
Rate for Payer: IEHP medi-cal $4.83
Rate for Payer: IEHP Medicare Advantage $2.93
Rate for Payer: Innovage PACE Commercial $4.40
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $1,239.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage $2.93
Rate for Payer: LLUH Dept of Risk Management WC $371.52
Rate for Payer: Molina Healthcare of CA Medi-Cal $3.93
Rate for Payer: Molina Healthcare of CA Medicare $3.93
Rate for Payer: Multiplan Commercial $1,393.20
Rate for Payer: Networks By Design Commercial $928.80
Rate for Payer: Prime Health Services Commercial $1,578.96
Rate for Payer: Prime Health Services Medicare $3.11
Rate for Payer: Riverside University Health MISP $3.22
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $1,114.56
Rate for Payer: TriValley Medical Group Commercial/Senior $1,114.56
Rate for Payer: United Healthcare All Other Commercial $928.80
Rate for Payer: United Healthcare All Other HMO $928.80
Rate for Payer: United Healthcare HMO Rider $928.80
Rate for Payer: United Healthcare Select/Navigate/Core $928.80
Rate for Payer: Vantage Medical Group Commercial/Exchange $4.40
Rate for Payer: Vantage Medical Group Medi-Cal $3.22
Rate for Payer: Vantage Medical Group Senior $2.93
Service Code NDC 50419-395-01
Hospital Revenue Code 259
Min. Negotiated Rate $25.73
Max. Negotiated Rate $115.79
Rate for Payer: Blue Shield of California Commercial $96.50
Rate for Payer: Blue Shield of California EPN $68.70
Rate for Payer: Cash Price $57.90
Rate for Payer: Central Health Plan Commercial $102.93
Rate for Payer: Cigna of CA HMO $90.06
Rate for Payer: Cigna of CA PPO $90.06
Rate for Payer: EPIC Health Plan Commercial $51.46
Rate for Payer: Galaxy Health WC $109.36
Rate for Payer: Global Benefits Group Commercial $77.20
Rate for Payer: Health Management Network EPO/PPO $115.79
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $85.82
Rate for Payer: LLUH Dept of Risk Management WC $25.73
Rate for Payer: Multiplan Commercial $96.50
Rate for Payer: Networks By Design Commercial $83.63
Rate for Payer: Prime Health Services Commercial $109.36
Service Code NDC 50419-395-01
Hospital Revenue Code 259
Min. Negotiated Rate $25.73
Max. Negotiated Rate $115.79
Rate for Payer: Aetna of CA HMO/PPO $78.14
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $109.36
Rate for Payer: AlphaCare Medical Group Medi-Cal $70.76
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $70.76
Rate for Payer: Anthem Blue Cross of CA Exchange $62.30
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $76.01
Rate for Payer: BCBS Transplant Transplant $77.20
Rate for Payer: Blue Shield of California Commercial $80.93
Rate for Payer: Blue Shield of California EPN $62.91
Rate for Payer: Cash Price $57.90
Rate for Payer: Central Health Plan Commercial $102.93
Rate for Payer: Cigna of CA HMO $90.06
Rate for Payer: Cigna of CA PPO $90.06
Rate for Payer: Dignity Health Commercial/Exchange $109.36
Rate for Payer: EPIC Health Plan Commercial $51.46
Rate for Payer: EPIC Health Plan Transplant $51.46
Rate for Payer: Galaxy Health WC $109.36
Rate for Payer: Global Benefits Group Commercial $77.20
Rate for Payer: Health Management Network EPO/PPO $115.79
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $96.50
Rate for Payer: IEHP medi-cal $45.03
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $85.82
Rate for Payer: LLUH Dept of Risk Management WC $25.73
Rate for Payer: Multiplan Commercial $96.50
Rate for Payer: Networks By Design Commercial $83.63
Rate for Payer: Prime Health Services Commercial $109.36
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $77.20
Rate for Payer: Riverside University Health MISP $51.46
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $77.20
Rate for Payer: TriValley Medical Group Commercial/Senior $77.20
Rate for Payer: United Healthcare All Other Commercial $64.33
Rate for Payer: United Healthcare All Other HMO $64.33
Rate for Payer: United Healthcare HMO Rider $64.33
Rate for Payer: United Healthcare Select/Navigate/Core $64.33
Rate for Payer: Vantage Medical Group Medi-Cal $109.36
Rate for Payer: Vantage Medical Group Senior $109.36
Service Code NDC 59676-562-01
Hospital Charge Code 1712433
Hospital Revenue Code 259
Min. Negotiated Rate $8.38
Max. Negotiated Rate $37.72
Rate for Payer: Aetna of CA HMO/PPO $25.45
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $35.62
Rate for Payer: AlphaCare Medical Group Medi-Cal $23.05
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $23.05
Rate for Payer: Anthem Blue Cross of CA Exchange $20.29
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $24.76
Rate for Payer: BCBS Transplant Transplant $25.15
Rate for Payer: Blue Shield of California Commercial $26.36
Rate for Payer: Blue Shield of California EPN $20.49
Rate for Payer: Cash Price $18.86
Rate for Payer: Central Health Plan Commercial $33.53
Rate for Payer: Cigna of CA HMO $29.34
Rate for Payer: Cigna of CA PPO $29.34
Rate for Payer: Dignity Health Commercial/Exchange $35.62
Rate for Payer: EPIC Health Plan Commercial $16.76
Rate for Payer: EPIC Health Plan Transplant $16.76
Rate for Payer: Galaxy Health WC $35.62
Rate for Payer: Global Benefits Group Commercial $25.15
Rate for Payer: Health Management Network EPO/PPO $37.72
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $31.43
Rate for Payer: IEHP medi-cal $14.67
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $27.95
Rate for Payer: LLUH Dept of Risk Management WC $8.38
Rate for Payer: Multiplan Commercial $31.43
Rate for Payer: Networks By Design Commercial $27.24
Rate for Payer: Prime Health Services Commercial $35.62
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $25.15
Rate for Payer: Riverside University Health MISP $16.76
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $25.15
Rate for Payer: TriValley Medical Group Commercial/Senior $25.15
Rate for Payer: United Healthcare All Other Commercial $20.96
Rate for Payer: United Healthcare All Other HMO $20.96
Rate for Payer: United Healthcare HMO Rider $20.96
Rate for Payer: United Healthcare Select/Navigate/Core $20.96
Rate for Payer: Vantage Medical Group Medi-Cal $35.62
Rate for Payer: Vantage Medical Group Senior $35.62
Service Code NDC 59676-562-01
Hospital Charge Code 1712433
Hospital Revenue Code 259
Min. Negotiated Rate $8.38
Max. Negotiated Rate $37.72
Rate for Payer: Blue Shield of California Commercial $31.43
Rate for Payer: Blue Shield of California EPN $22.38
Rate for Payer: Cash Price $18.86
Rate for Payer: Central Health Plan Commercial $33.53
Rate for Payer: Cigna of CA HMO $29.34
Rate for Payer: Cigna of CA PPO $29.34
Rate for Payer: EPIC Health Plan Commercial $16.76
Rate for Payer: Galaxy Health WC $35.62
Rate for Payer: Global Benefits Group Commercial $25.15
Rate for Payer: Health Management Network EPO/PPO $37.72
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $27.95
Rate for Payer: LLUH Dept of Risk Management WC $8.38
Rate for Payer: Multiplan Commercial $31.43
Rate for Payer: Networks By Design Commercial $27.24
Rate for Payer: Prime Health Services Commercial $35.62
Service Code NDC 59676-575-30
Hospital Charge Code ERX208697
Hospital Revenue Code 259
Min. Negotiated Rate $19.16
Max. Negotiated Rate $86.22
Rate for Payer: Blue Shield of California Commercial $71.85
Rate for Payer: Blue Shield of California EPN $51.16
Rate for Payer: Cash Price $43.11
Rate for Payer: Central Health Plan Commercial $76.64
Rate for Payer: Cigna of CA HMO $67.06
Rate for Payer: Cigna of CA PPO $67.06
Rate for Payer: EPIC Health Plan Commercial $38.32
Rate for Payer: Galaxy Health WC $81.43
Rate for Payer: Global Benefits Group Commercial $57.48
Rate for Payer: Health Management Network EPO/PPO $86.22
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $63.90
Rate for Payer: LLUH Dept of Risk Management WC $19.16
Rate for Payer: Multiplan Commercial $71.85
Rate for Payer: Networks By Design Commercial $62.27
Rate for Payer: Prime Health Services Commercial $81.43
Service Code NDC 59676-575-30
Hospital Charge Code ERX208697
Hospital Revenue Code 259
Min. Negotiated Rate $19.16
Max. Negotiated Rate $86.22
Rate for Payer: Aetna of CA HMO/PPO $58.18
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $81.43
Rate for Payer: AlphaCare Medical Group Medi-Cal $52.69
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $52.69
Rate for Payer: Anthem Blue Cross of CA Exchange $46.39
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $56.60
Rate for Payer: BCBS Transplant Transplant $57.48
Rate for Payer: Blue Shield of California Commercial $60.26
Rate for Payer: Blue Shield of California EPN $46.85
Rate for Payer: Cash Price $43.11
Rate for Payer: Central Health Plan Commercial $76.64
Rate for Payer: Cigna of CA HMO $67.06
Rate for Payer: Cigna of CA PPO $67.06
Rate for Payer: Dignity Health Commercial/Exchange $81.43
Rate for Payer: EPIC Health Plan Commercial $38.32
Rate for Payer: EPIC Health Plan Transplant $38.32
Rate for Payer: Galaxy Health WC $81.43
Rate for Payer: Global Benefits Group Commercial $57.48
Rate for Payer: Health Management Network EPO/PPO $86.22
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $71.85
Rate for Payer: IEHP medi-cal $33.53
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $63.90
Rate for Payer: LLUH Dept of Risk Management WC $19.16
Rate for Payer: Multiplan Commercial $71.85
Rate for Payer: Networks By Design Commercial $62.27
Rate for Payer: Prime Health Services Commercial $81.43
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $57.48
Rate for Payer: Riverside University Health MISP $38.32
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $57.48
Rate for Payer: TriValley Medical Group Commercial/Senior $57.48
Rate for Payer: United Healthcare All Other Commercial $47.90
Rate for Payer: United Healthcare All Other HMO $47.90
Rate for Payer: United Healthcare HMO Rider $47.90
Rate for Payer: United Healthcare Select/Navigate/Core $47.90
Rate for Payer: Vantage Medical Group Medi-Cal $81.43
Rate for Payer: Vantage Medical Group Senior $81.43
Service Code NDC 68180-346-06
Hospital Charge Code 1712557
Hospital Revenue Code 259
Min. Negotiated Rate $14.48
Max. Negotiated Rate $65.17
Rate for Payer: Blue Shield of California Commercial $54.31
Rate for Payer: Blue Shield of California EPN $38.67
Rate for Payer: Cash Price $32.58
Rate for Payer: Central Health Plan Commercial $57.93
Rate for Payer: Cigna of CA HMO $50.69
Rate for Payer: Cigna of CA PPO $50.69
Rate for Payer: EPIC Health Plan Commercial $28.96
Rate for Payer: Galaxy Health WC $61.55
Rate for Payer: Global Benefits Group Commercial $43.45
Rate for Payer: Health Management Network EPO/PPO $65.17
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $48.30
Rate for Payer: LLUH Dept of Risk Management WC $14.48
Rate for Payer: Multiplan Commercial $54.31
Rate for Payer: Networks By Design Commercial $47.07
Rate for Payer: Prime Health Services Commercial $61.55
Service Code NDC 59676-566-30
Hospital Charge Code 1712557
Hospital Revenue Code 259
Min. Negotiated Rate $16.76
Max. Negotiated Rate $75.43
Rate for Payer: Aetna of CA HMO/PPO $50.90
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $71.24
Rate for Payer: AlphaCare Medical Group Medi-Cal $46.10
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $46.10
Rate for Payer: Anthem Blue Cross of CA Exchange $40.58
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $49.51
Rate for Payer: BCBS Transplant Transplant $50.29
Rate for Payer: Blue Shield of California Commercial $52.72
Rate for Payer: Blue Shield of California EPN $40.98
Rate for Payer: Cash Price $37.71
Rate for Payer: Central Health Plan Commercial $67.05
Rate for Payer: Cigna of CA HMO $58.67
Rate for Payer: Cigna of CA PPO $58.67
Rate for Payer: Dignity Health Commercial/Exchange $71.24
Rate for Payer: EPIC Health Plan Commercial $33.52
Rate for Payer: EPIC Health Plan Transplant $33.52
Rate for Payer: Galaxy Health WC $71.24
Rate for Payer: Global Benefits Group Commercial $50.29
Rate for Payer: Health Management Network EPO/PPO $75.43
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $62.86
Rate for Payer: IEHP medi-cal $29.33
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $55.90
Rate for Payer: LLUH Dept of Risk Management WC $16.76
Rate for Payer: Multiplan Commercial $62.86
Rate for Payer: Networks By Design Commercial $54.48
Rate for Payer: Prime Health Services Commercial $71.24
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $50.29
Rate for Payer: Riverside University Health MISP $33.52
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $50.29
Rate for Payer: TriValley Medical Group Commercial/Senior $50.29
Rate for Payer: United Healthcare All Other Commercial $41.90
Rate for Payer: United Healthcare All Other HMO $41.90
Rate for Payer: United Healthcare HMO Rider $41.90
Rate for Payer: United Healthcare Select/Navigate/Core $41.90
Rate for Payer: Vantage Medical Group Medi-Cal $71.24
Rate for Payer: Vantage Medical Group Senior $71.24
Service Code NDC 59676-566-30
Hospital Charge Code 1712557
Hospital Revenue Code 259
Min. Negotiated Rate $16.76
Max. Negotiated Rate $75.43
Rate for Payer: Blue Shield of California Commercial $62.86
Rate for Payer: Blue Shield of California EPN $44.75
Rate for Payer: Cash Price $37.71
Rate for Payer: Central Health Plan Commercial $67.05
Rate for Payer: Cigna of CA HMO $58.67
Rate for Payer: Cigna of CA PPO $58.67
Rate for Payer: EPIC Health Plan Commercial $33.52
Rate for Payer: Galaxy Health WC $71.24
Rate for Payer: Global Benefits Group Commercial $50.29
Rate for Payer: Health Management Network EPO/PPO $75.43
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $55.90
Rate for Payer: LLUH Dept of Risk Management WC $16.76
Rate for Payer: Multiplan Commercial $62.86
Rate for Payer: Networks By Design Commercial $54.48
Rate for Payer: Prime Health Services Commercial $71.24
Service Code NDC 68180-346-06
Hospital Charge Code 1712557
Hospital Revenue Code 259
Min. Negotiated Rate $14.48
Max. Negotiated Rate $65.17
Rate for Payer: Aetna of CA HMO/PPO $43.97
Rate for Payer: AlphaCare Medical Group Commercial/Exchange $61.55
Rate for Payer: AlphaCare Medical Group Medi-Cal $39.83
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product $39.83
Rate for Payer: Anthem Blue Cross of CA Exchange $35.06
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $42.78
Rate for Payer: BCBS Transplant Transplant $43.45
Rate for Payer: Blue Shield of California Commercial $45.55
Rate for Payer: Blue Shield of California EPN $35.41
Rate for Payer: Cash Price $32.58
Rate for Payer: Central Health Plan Commercial $57.93
Rate for Payer: Cigna of CA HMO $50.69
Rate for Payer: Cigna of CA PPO $50.69
Rate for Payer: Dignity Health Commercial/Exchange $61.55
Rate for Payer: EPIC Health Plan Commercial $28.96
Rate for Payer: EPIC Health Plan Transplant $28.96
Rate for Payer: Galaxy Health WC $61.55
Rate for Payer: Global Benefits Group Commercial $43.45
Rate for Payer: Health Management Network EPO/PPO $65.17
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other $54.31
Rate for Payer: IEHP medi-cal $25.34
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded $48.30
Rate for Payer: LLUH Dept of Risk Management WC $14.48
Rate for Payer: Multiplan Commercial $54.31
Rate for Payer: Networks By Design Commercial $47.07
Rate for Payer: Prime Health Services Commercial $61.55
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior $43.45
Rate for Payer: Riverside University Health MISP $28.96
Rate for Payer: Temecula Valley Physicians Medical Group Commercial $43.45
Rate for Payer: TriValley Medical Group Commercial/Senior $43.45
Rate for Payer: United Healthcare All Other Commercial $36.20
Rate for Payer: United Healthcare All Other HMO $36.20
Rate for Payer: United Healthcare HMO Rider $36.20
Rate for Payer: United Healthcare Select/Navigate/Core $36.20
Rate for Payer: Vantage Medical Group Medi-Cal $61.55
Rate for Payer: Vantage Medical Group Senior $61.55