|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$961.20 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.80
|
| Rate for Payer: Blue Shield of California Commercial |
$672.84
|
| Rate for Payer: Blue Shield of California EPN |
$424.00
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$801.00
|
| Rate for Payer: Networks By Design Commercial |
$694.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| 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 |
$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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$961.20 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$747.60
|
| 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: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$801.00
|
| Rate for Payer: Networks By Design Commercial |
$694.20
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
IP
|
$1,581.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.20 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Adventist Health Commercial |
$316.20
|
| Rate for Payer: Cash Price |
$711.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,264.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,106.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$632.40
|
| Rate for Payer: EPIC Health Plan Senior |
$632.40
|
| Rate for Payer: Galaxy Health WC |
$1,343.85
|
| Rate for Payer: Global Benefits Group Commercial |
$948.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,422.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,003.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$932.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.20
|
| Rate for Payer: Multiplan Commercial |
$1,185.75
|
| Rate for Payer: Networks By Design Commercial |
$1,027.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,343.85
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
OP
|
$1,581.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.85 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Adventist Health Commercial |
$316.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$390.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$542.40
|
| Rate for Payer: Blue Shield of California Commercial |
$996.03
|
| Rate for Payer: Blue Shield of California EPN |
$627.66
|
| Rate for Payer: Cash Price |
$711.45
|
| Rate for Payer: Cash Price |
$711.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,264.80
|
| Rate for Payer: Cigna of CA HMO |
$1,011.84
|
| Rate for Payer: Cigna of CA PPO |
$1,169.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,106.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,343.85
|
| Rate for Payer: Global Benefits Group Commercial |
$948.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,422.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,003.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,185.75
|
| Rate for Payer: Networks By Design Commercial |
$1,027.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,343.85
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$948.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$948.60
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.13 |
| Max. Negotiated Rate |
$1,563.30 |
| Rate for Payer: Adventist Health Commercial |
$347.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$423.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,094.31
|
| Rate for Payer: Blue Shield of California EPN |
$689.59
|
| Rate for Payer: Cash Price |
$781.65
|
| Rate for Payer: Cash Price |
$781.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,389.60
|
| Rate for Payer: Cigna of CA HMO |
$1,111.68
|
| Rate for Payer: Cigna of CA PPO |
$1,285.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,476.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,042.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,563.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,102.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,302.75
|
| Rate for Payer: Networks By Design Commercial |
$1,129.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,476.45
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,042.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,042.20
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$1,563.30 |
| Rate for Payer: Adventist Health Commercial |
$347.40
|
| Rate for Payer: Cash Price |
$781.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,389.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$694.80
|
| Rate for Payer: EPIC Health Plan Senior |
$694.80
|
| Rate for Payer: Galaxy Health WC |
$1,476.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,042.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,563.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,102.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,024.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.40
|
| Rate for Payer: Multiplan Commercial |
$1,302.75
|
| Rate for Payer: Networks By Design Commercial |
$1,129.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,476.45
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.75 |
| Max. Negotiated Rate |
$1,642.50 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$508.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$706.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,149.75
|
| Rate for Payer: Blue Shield of California EPN |
$724.52
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,460.00
|
| Rate for Payer: Cigna of CA HMO |
$1,168.00
|
| Rate for Payer: Cigna of CA PPO |
$1,350.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,277.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,642.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,158.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,095.00
|
| 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: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$365.00 |
| Max. Negotiated Rate |
$1,642.50 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,460.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,277.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$730.00
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,642.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,158.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,076.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.00
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.31
|
| Rate for Payer: Blue Shield of California Commercial |
$329.49
|
| Rate for Payer: Blue Shield of California EPN |
$207.63
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$334.72
|
| Rate for Payer: Cigna of CA PPO |
$387.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Central Health Plan Commercial |
$524.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$458.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$589.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.00
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
| Rate for Payer: Networks By Design Commercial |
$425.75
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.80
|
| Rate for Payer: Blue Shield of California Commercial |
$412.65
|
| Rate for Payer: Blue Shield of California EPN |
$260.04
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Central Health Plan Commercial |
$524.00
|
| Rate for Payer: Cigna of CA HMO |
$419.20
|
| Rate for Payer: Cigna of CA PPO |
$484.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$458.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$589.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
| Rate for Payer: Networks By Design Commercial |
$425.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.00
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.86 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Adventist Health Commercial |
$259.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$237.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.65
|
| Rate for Payer: Blue Shield of California Commercial |
$816.48
|
| Rate for Payer: Blue Shield of California EPN |
$514.51
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.80
|
| Rate for Payer: Cigna of CA HMO |
$829.44
|
| Rate for Payer: Cigna of CA PPO |
$959.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,166.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$822.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$777.60
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Adventist Health Commercial |
$259.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.40
|
| Rate for Payer: EPIC Health Plan Senior |
$518.40
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$822.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$764.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
IP
|
$1,446.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$289.20 |
| Max. Negotiated Rate |
$1,301.40 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,012.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$578.40
|
| Rate for Payer: EPIC Health Plan Senior |
$578.40
|
| Rate for Payer: Galaxy Health WC |
$1,229.10
|
| Rate for Payer: Global Benefits Group Commercial |
$867.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,301.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$918.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$853.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.20
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
| Rate for Payer: Networks By Design Commercial |
$939.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,229.10
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
OP
|
$1,446.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$1,301.40 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.51
|
| Rate for Payer: Blue Shield of California Commercial |
$910.98
|
| Rate for Payer: Blue Shield of California EPN |
$574.06
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,156.80
|
| Rate for Payer: Cigna of CA HMO |
$925.44
|
| Rate for Payer: Cigna of CA PPO |
$1,070.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,012.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,229.10
|
| Rate for Payer: Global Benefits Group Commercial |
$867.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,301.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$918.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
| Rate for Payer: Networks By Design Commercial |
$939.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,229.10
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$867.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$867.60
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,367.10 |
| Rate for Payer: Adventist Health Commercial |
$303.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$341.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$474.72
|
| Rate for Payer: Blue Shield of California Commercial |
$956.97
|
| Rate for Payer: Blue Shield of California EPN |
$603.04
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,215.20
|
| Rate for Payer: Cigna of CA HMO |
$972.16
|
| Rate for Payer: Cigna of CA PPO |
$1,124.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,063.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,291.15
|
| Rate for Payer: Global Benefits Group Commercial |
$911.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,367.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$964.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,139.25
|
| Rate for Payer: Networks By Design Commercial |
$987.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,291.15
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$911.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$911.40
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$1,367.10 |
| Rate for Payer: Adventist Health Commercial |
$303.80
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,215.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,063.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$607.60
|
| Rate for Payer: EPIC Health Plan Senior |
$607.60
|
| Rate for Payer: Galaxy Health WC |
$1,291.15
|
| Rate for Payer: Global Benefits Group Commercial |
$911.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,367.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$964.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$896.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.80
|
| Rate for Payer: Multiplan Commercial |
$1,139.25
|
| Rate for Payer: Networks By Design Commercial |
$987.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,291.15
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$171.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.84
|
| Rate for Payer: Blue Shield of California Commercial |
$501.48
|
| Rate for Payer: Blue Shield of California EPN |
$316.01
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$995.40 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Central Health Plan Commercial |
$884.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$774.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.40
|
| Rate for Payer: EPIC Health Plan Senior |
$442.40
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$995.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$652.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.20
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$995.40 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$181.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$253.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.96
|
| Rate for Payer: Blue Shield of California Commercial |
$696.78
|
| Rate for Payer: Blue Shield of California EPN |
$439.08
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Central Health Plan Commercial |
$884.80
|
| Rate for Payer: Cigna of CA HMO |
$707.84
|
| Rate for Payer: Cigna of CA PPO |
$818.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$774.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$995.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$663.60
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$1,228.50 |
| Rate for Payer: Adventist Health Commercial |
$273.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.05
|
| Rate for Payer: Blue Shield of California Commercial |
$859.95
|
| Rate for Payer: Blue Shield of California EPN |
$541.90
|
| Rate for Payer: Cash Price |
$614.25
|
| Rate for Payer: Cash Price |
$614.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,092.00
|
| Rate for Payer: Cigna of CA HMO |
$873.60
|
| Rate for Payer: Cigna of CA PPO |
$1,010.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$955.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,160.25
|
| Rate for Payer: Global Benefits Group Commercial |
$819.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$866.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,023.75
|
| Rate for Payer: Networks By Design Commercial |
$887.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$819.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$819.00
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$1,228.50 |
| Rate for Payer: Adventist Health Commercial |
$273.00
|
| Rate for Payer: Cash Price |
$614.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,092.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$955.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.00
|
| Rate for Payer: EPIC Health Plan Senior |
$546.00
|
| Rate for Payer: Galaxy Health WC |
$1,160.25
|
| Rate for Payer: Global Benefits Group Commercial |
$819.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,228.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$866.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$805.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.75
|
| Rate for Payer: Networks By Design Commercial |
$887.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,160.25
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
