|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$777.75 |
| Rate for Payer: Cash Price |
$411.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.00
|
| Rate for Payer: Galaxy Health WC |
$777.75
|
| Rate for Payer: Global Benefits Group Commercial |
$549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: Networks By Design Commercial |
$594.75
|
| Rate for Payer: Prime Health Services Commercial |
$777.75
|
|
|
HC WRIST LIMITED
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.40 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.40
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
|
|
HC WRIST LIMITED
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.74
|
| Rate for Payer: Blue Distinction Transplant |
$456.00
|
| Rate for Payer: Blue Shield of California Commercial |
$449.16
|
| Rate for Payer: Blue Shield of California EPN |
$356.44
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna of CA HMO |
$486.40
|
| Rate for Payer: Cigna of CA PPO |
$562.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$570.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.47
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$47.16
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Media |
$13.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$457.20 |
| Max. Negotiated Rate |
$1,619.25 |
| Rate for Payer: Cash Price |
$857.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.00
|
| Rate for Payer: Galaxy Health WC |
$1,619.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| Rate for Payer: Multiplan Commercial |
$1,524.00
|
| Rate for Payer: Networks By Design Commercial |
$1,238.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,619.25
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$300.09 |
| Max. Negotiated Rate |
$1,619.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,142.61
|
| Rate for Payer: Blue Distinction Transplant |
$1,143.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.86
|
| Rate for Payer: Blue Shield of California EPN |
$893.44
|
| Rate for Payer: Cash Price |
$857.25
|
| Rate for Payer: Cash Price |
$857.25
|
| Rate for Payer: Cigna of CA HMO |
$1,219.20
|
| Rate for Payer: Cigna of CA PPO |
$1,409.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,619.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,428.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,524.00
|
| Rate for Payer: Networks By Design Commercial |
$1,238.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,619.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,143.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,143.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.19
|
| Rate for Payer: United Healthcare All Other HMO |
$518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$518.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$751.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$161.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.75
|
| Rate for Payer: Blue Distinction Transplant |
$530.40
|
| Rate for Payer: Blue Shield of California Commercial |
$522.44
|
| Rate for Payer: Blue Shield of California EPN |
$414.60
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna of CA HMO |
$565.76
|
| Rate for Payer: Cigna of CA PPO |
$654.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$751.40
|
| Rate for Payer: Global Benefits Group Commercial |
$530.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$663.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: Networks By Design Commercial |
$574.60
|
| Rate for Payer: Prime Health Services Commercial |
$751.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$530.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$530.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$751.40 |
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.60
|
| Rate for Payer: Galaxy Health WC |
$751.40
|
| Rate for Payer: Global Benefits Group Commercial |
$530.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.16
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: Networks By Design Commercial |
$574.60
|
| Rate for Payer: Prime Health Services Commercial |
$751.40
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.99 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.30
|
| Rate for Payer: Blue Distinction Transplant |
$784.80
|
| Rate for Payer: Blue Shield of California Commercial |
$773.03
|
| Rate for Payer: Blue Shield of California EPN |
$613.45
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna of CA HMO |
$837.12
|
| Rate for Payer: Cigna of CA PPO |
$967.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,111.80
|
| Rate for Payer: Global Benefits Group Commercial |
$784.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$872.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,046.40
|
| Rate for Payer: Networks By Design Commercial |
$850.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,111.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$784.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$784.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.92 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.20
|
| Rate for Payer: Galaxy Health WC |
$1,111.80
|
| Rate for Payer: Global Benefits Group Commercial |
$784.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$872.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.92
|
| Rate for Payer: Multiplan Commercial |
$1,046.40
|
| Rate for Payer: Networks By Design Commercial |
$850.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,111.80
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
IP
|
$1,438.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.12 |
| Max. Negotiated Rate |
$1,222.30 |
| Rate for Payer: Cash Price |
$647.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.20
|
| Rate for Payer: Galaxy Health WC |
$1,222.30
|
| Rate for Payer: Global Benefits Group Commercial |
$862.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$959.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.12
|
| Rate for Payer: Multiplan Commercial |
$1,150.40
|
| Rate for Payer: Networks By Design Commercial |
$934.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,222.30
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
OP
|
$1,438.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$1,222.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$319.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.19
|
| Rate for Payer: Blue Distinction Transplant |
$862.80
|
| Rate for Payer: Blue Shield of California Commercial |
$849.86
|
| Rate for Payer: Blue Shield of California EPN |
$674.42
|
| Rate for Payer: Cash Price |
$647.10
|
| Rate for Payer: Cash Price |
$647.10
|
| Rate for Payer: Cigna of CA HMO |
$920.32
|
| Rate for Payer: Cigna of CA PPO |
$1,064.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,222.30
|
| Rate for Payer: Global Benefits Group Commercial |
$862.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,078.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$959.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,150.40
|
| Rate for Payer: Networks By Design Commercial |
$934.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,222.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$862.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
IP
|
$1,510.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$1,283.50 |
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.00
|
| Rate for Payer: Galaxy Health WC |
$1,283.50
|
| Rate for Payer: Global Benefits Group Commercial |
$906.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Multiplan Commercial |
$1,208.00
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,283.50
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
OP
|
$1,510.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,283.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$386.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.58
|
| Rate for Payer: Blue Distinction Transplant |
$906.00
|
| Rate for Payer: Blue Shield of California Commercial |
$892.41
|
| Rate for Payer: Blue Shield of California EPN |
$708.19
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cigna of CA HMO |
$966.40
|
| Rate for Payer: Cigna of CA PPO |
$1,117.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,283.50
|
| Rate for Payer: Global Benefits Group Commercial |
$906.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,132.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,208.00
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,283.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$906.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$906.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.92 |
| Max. Negotiated Rate |
$368.05 |
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.20
|
| Rate for Payer: Galaxy Health WC |
$368.05
|
| Rate for Payer: Global Benefits Group Commercial |
$259.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.92
|
| Rate for Payer: Multiplan Commercial |
$346.40
|
| Rate for Payer: Networks By Design Commercial |
$281.45
|
| Rate for Payer: Prime Health Services Commercial |
$368.05
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$368.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.25
|
| Rate for Payer: Blue Distinction Transplant |
$259.80
|
| Rate for Payer: Blue Shield of California Commercial |
$255.90
|
| Rate for Payer: Blue Shield of California EPN |
$203.08
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cigna of CA HMO |
$277.12
|
| Rate for Payer: Cigna of CA PPO |
$320.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$368.05
|
| Rate for Payer: Global Benefits Group Commercial |
$259.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$324.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$346.40
|
| Rate for Payer: Networks By Design Commercial |
$281.45
|
| Rate for Payer: Prime Health Services Commercial |
$368.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.08 |
| Max. Negotiated Rate |
$460.70 |
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.80
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.08
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$460.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.58
|
| Rate for Payer: Blue Distinction Transplant |
$325.20
|
| Rate for Payer: Blue Shield of California Commercial |
$320.32
|
| Rate for Payer: Blue Shield of California EPN |
$254.20
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cigna of CA HMO |
$346.88
|
| Rate for Payer: Cigna of CA PPO |
$401.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$406.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.28 |
| Max. Negotiated Rate |
$911.20 |
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.80
|
| Rate for Payer: Galaxy Health WC |
$911.20
|
| Rate for Payer: Global Benefits Group Commercial |
$643.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.28
|
| Rate for Payer: Multiplan Commercial |
$857.60
|
| Rate for Payer: Networks By Design Commercial |
$696.80
|
| Rate for Payer: Prime Health Services Commercial |
$911.20
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$911.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$177.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.27
|
| Rate for Payer: Blue Distinction Transplant |
$643.20
|
| Rate for Payer: Blue Shield of California Commercial |
$633.55
|
| Rate for Payer: Blue Shield of California EPN |
$502.77
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna of CA HMO |
$686.08
|
| Rate for Payer: Cigna of CA PPO |
$793.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$911.20
|
| Rate for Payer: Global Benefits Group Commercial |
$643.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$804.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$857.60
|
| Rate for Payer: Networks By Design Commercial |
$696.80
|
| Rate for Payer: Prime Health Services Commercial |
$911.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$643.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$643.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.32 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$214.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.89
|
| Rate for Payer: Blue Distinction Transplant |
$718.20
|
| Rate for Payer: Blue Shield of California Commercial |
$707.43
|
| Rate for Payer: Blue Shield of California EPN |
$561.39
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cigna of CA HMO |
$766.08
|
| Rate for Payer: Cigna of CA PPO |
$885.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$897.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$798.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.28 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.80
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$798.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
|
IP
|
$1,257.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.68 |
| Max. Negotiated Rate |
$1,068.45 |
| Rate for Payer: Cash Price |
$565.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.80
|
| Rate for Payer: Galaxy Health WC |
$1,068.45
|
| Rate for Payer: Global Benefits Group Commercial |
$754.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$838.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.68
|
| Rate for Payer: Multiplan Commercial |
$1,005.60
|
| Rate for Payer: Networks By Design Commercial |
$817.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,068.45
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
|
OP
|
$1,257.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$1,068.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$258.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$428.25
|
| Rate for Payer: Blue Distinction Transplant |
$754.20
|
| Rate for Payer: Blue Shield of California Commercial |
$742.89
|
| Rate for Payer: Blue Shield of California EPN |
$589.53
|
| Rate for Payer: Cash Price |
$565.65
|
| Rate for Payer: Cash Price |
$565.65
|
| Rate for Payer: Cigna of CA HMO |
$804.48
|
| Rate for Payer: Cigna of CA PPO |
$930.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,068.45
|
| Rate for Payer: Global Benefits Group Commercial |
$754.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$942.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$838.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,005.60
|
| Rate for Payer: Networks By Design Commercial |
$817.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,068.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$754.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$754.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$560.15 |
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
|
