|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.20 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Cash Price |
$413.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.40
|
| Rate for Payer: EPIC Health Plan Senior |
$300.40
|
| Rate for Payer: Galaxy Health WC |
$638.35
|
| Rate for Payer: Global Benefits Group Commercial |
$450.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.24
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Networks By Design Commercial |
$488.15
|
| Rate for Payer: Prime Health Services Commercial |
$638.35
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.33 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$492.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.86
|
| Rate for Payer: Blue Shield of California Commercial |
$459.61
|
| Rate for Payer: Blue Shield of California EPN |
$303.40
|
| Rate for Payer: Cash Price |
$413.05
|
| Rate for Payer: Cash Price |
$413.05
|
| Rate for Payer: Cigna of CA HMO |
$480.64
|
| Rate for Payer: Cigna of CA PPO |
$555.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$638.35
|
| Rate for Payer: Global Benefits Group Commercial |
$450.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Networks By Design Commercial |
$488.15
|
| Rate for Payer: Prime Health Services Commercial |
$638.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
OP
|
$1,112.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$945.20 |
| Rate for Payer: Adventist Health Commercial |
$222.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$729.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.72
|
| Rate for Payer: Blue Shield of California Commercial |
$680.54
|
| Rate for Payer: Blue Shield of California EPN |
$449.25
|
| Rate for Payer: Cash Price |
$611.60
|
| Rate for Payer: Cash Price |
$611.60
|
| Rate for Payer: Cigna of CA HMO |
$711.68
|
| Rate for Payer: Cigna of CA PPO |
$822.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$945.20
|
| Rate for Payer: Global Benefits Group Commercial |
$667.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$741.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$889.60
|
| Rate for Payer: Networks By Design Commercial |
$722.80
|
| Rate for Payer: Prime Health Services Commercial |
$945.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$667.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$667.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.76
|
| Rate for Payer: United Healthcare All Other HMO |
$257.76
|
| Rate for Payer: United Healthcare HMO Rider |
$257.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
IP
|
$1,112.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.40 |
| Max. Negotiated Rate |
$945.20 |
| Rate for Payer: Adventist Health Commercial |
$222.40
|
| Rate for Payer: Cash Price |
$611.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.80
|
| Rate for Payer: EPIC Health Plan Senior |
$444.80
|
| Rate for Payer: Galaxy Health WC |
$945.20
|
| Rate for Payer: Global Benefits Group Commercial |
$667.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$741.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$688.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.88
|
| Rate for Payer: Multiplan Commercial |
$889.60
|
| Rate for Payer: Networks By Design Commercial |
$722.80
|
| Rate for Payer: Prime Health Services Commercial |
$945.20
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.68 |
| Max. Negotiated Rate |
$1,038.70 |
| Rate for Payer: Adventist Health Commercial |
$244.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$801.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$575.07
|
| Rate for Payer: Blue Shield of California Commercial |
$747.86
|
| Rate for Payer: Blue Shield of California EPN |
$493.69
|
| Rate for Payer: Cash Price |
$672.10
|
| Rate for Payer: Cash Price |
$672.10
|
| Rate for Payer: Cigna of CA HMO |
$782.08
|
| Rate for Payer: Cigna of CA PPO |
$904.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$977.60
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$733.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$733.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.44
|
| Rate for Payer: United Healthcare All Other HMO |
$491.44
|
| Rate for Payer: United Healthcare HMO Rider |
$491.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$1,038.70 |
| Rate for Payer: Adventist Health Commercial |
$244.40
|
| Rate for Payer: Cash Price |
$672.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.80
|
| Rate for Payer: EPIC Health Plan Senior |
$488.80
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$756.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.28
|
| Rate for Payer: Multiplan Commercial |
$977.60
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
OP
|
$1,284.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.82 |
| Max. Negotiated Rate |
$1,091.40 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$842.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.24
|
| Rate for Payer: Blue Shield of California Commercial |
$785.81
|
| Rate for Payer: Blue Shield of California EPN |
$518.74
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna of CA HMO |
$821.76
|
| Rate for Payer: Cigna of CA PPO |
$950.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,091.40
|
| Rate for Payer: Global Benefits Group Commercial |
$770.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,027.20
|
| Rate for Payer: Networks By Design Commercial |
$834.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$770.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$770.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.44
|
| Rate for Payer: United Healthcare All Other HMO |
$491.44
|
| Rate for Payer: United Healthcare HMO Rider |
$491.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
IP
|
$1,284.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$1,091.40 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$513.60
|
| Rate for Payer: Galaxy Health WC |
$1,091.40
|
| Rate for Payer: Global Benefits Group Commercial |
$770.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$794.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.16
|
| Rate for Payer: Multiplan Commercial |
$1,027.20
|
| Rate for Payer: Networks By Design Commercial |
$834.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.40
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$241.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.04
|
| Rate for Payer: Blue Shield of California Commercial |
$225.22
|
| Rate for Payer: Blue Shield of California EPN |
$148.67
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$235.52
|
| Rate for Payer: Cigna of CA PPO |
$272.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$391.85 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Cash Price |
$253.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.40
|
| Rate for Payer: EPIC Health Plan Senior |
$184.40
|
| Rate for Payer: Galaxy Health WC |
$391.85
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$307.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$285.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.64
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| Rate for Payer: Prime Health Services Commercial |
$391.85
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$391.85 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$302.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.53
|
| Rate for Payer: Blue Shield of California Commercial |
$282.13
|
| Rate for Payer: Blue Shield of California EPN |
$186.24
|
| Rate for Payer: Cash Price |
$253.55
|
| Rate for Payer: Cash Price |
$253.55
|
| Rate for Payer: Cigna of CA HMO |
$295.04
|
| Rate for Payer: Cigna of CA PPO |
$341.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$391.85
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$307.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| Rate for Payer: Prime Health Services Commercial |
$391.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$364.40
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.64
|
| Rate for Payer: Multiplan Commercial |
$728.80
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.91
|
| Rate for Payer: Blue Shield of California Commercial |
$557.53
|
| Rate for Payer: Blue Shield of California EPN |
$368.04
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cigna of CA HMO |
$583.04
|
| Rate for Payer: Cigna of CA PPO |
$674.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$728.80
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.76
|
| Rate for Payer: United Healthcare All Other HMO |
$257.76
|
| Rate for Payer: United Healthcare HMO Rider |
$257.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.67 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$667.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$622.40
|
| Rate for Payer: Blue Shield of California EPN |
$410.87
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cigna of CA HMO |
$650.88
|
| Rate for Payer: Cigna of CA PPO |
$752.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$610.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.76
|
| Rate for Payer: United Healthcare All Other HMO |
$257.76
|
| Rate for Payer: United Healthcare HMO Rider |
$257.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$629.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$700.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.62
|
| Rate for Payer: Blue Shield of California Commercial |
$653.62
|
| Rate for Payer: Blue Shield of California EPN |
$431.47
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna of CA HMO |
$683.52
|
| Rate for Payer: Cigna of CA PPO |
$790.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$694.20
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.44
|
| Rate for Payer: United Healthcare All Other HMO |
$491.44
|
| Rate for Payer: United Healthcare HMO Rider |
$491.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$694.20
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.54 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$367.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.27
|
| Rate for Payer: Blue Shield of California Commercial |
$342.72
|
| Rate for Payer: Blue Shield of California EPN |
$226.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Cash Price |
$427.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.72
|
| Rate for Payer: Blue Shield of California Commercial |
$476.14
|
| Rate for Payer: Blue Shield of California EPN |
$314.31
|
| Rate for Payer: Cash Price |
$427.90
|
| Rate for Payer: Cash Price |
$427.90
|
| Rate for Payer: Cigna of CA HMO |
$497.92
|
| Rate for Payer: Cigna of CA PPO |
$575.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: Adventist Health Commercial |
$153.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$503.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.85
|
| Rate for Payer: Blue Shield of California Commercial |
$470.02
|
| Rate for Payer: Blue Shield of California EPN |
$310.27
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna of CA HMO |
$491.52
|
| Rate for Payer: Cigna of CA PPO |
$568.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$614.40
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$460.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$460.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.76
|
| Rate for Payer: United Healthcare All Other HMO |
$257.76
|
| Rate for Payer: United Healthcare HMO Rider |
$257.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: Adventist Health Commercial |
$153.60
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.20
|
| Rate for Payer: EPIC Health Plan Senior |
$307.20
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$475.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.32
|
| Rate for Payer: Multiplan Commercial |
$614.40
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.69
|
| Rate for Payer: Blue Shield of California Commercial |
$504.90
|
| Rate for Payer: Blue Shield of California EPN |
$333.30
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cigna of CA HMO |
$528.00
|
| Rate for Payer: Cigna of CA PPO |
$610.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$536.25
|
| Rate for Payer: Prime Health Services Commercial |
$701.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
