|
HC XA INHIBITION LMW HEPARIN
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
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 |
$98.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.69
|
| Rate for Payer: BCBS Transplant Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.48
|
| Rate for Payer: Caremore Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| 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: 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 Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: IEHP medi-cal |
$21.60
|
| Rate for Payer: IEHP Medicare Advantage |
$13.09
|
| Rate for Payer: Innovage PACE Commercial |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: Riverside University Health MISP |
$14.40
|
| 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 XE 133, PER 10 MCI
|
Facility
IP
|
$192.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Blue Shield of California Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California EPN |
$102.53
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
|
|
HC XE 133, PER 10 MCI
|
Facility
OP
|
$192.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.34
|
| Rate for Payer: BCBS Transplant Transplant |
$115.20
|
| Rate for Payer: Blue Shield of California Commercial |
$120.77
|
| Rate for Payer: Blue Shield of California EPN |
$93.89
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$144.00
|
| Rate for Payer: IEHP medi-cal |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Riverside University Health MISP |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Other HMO |
$96.00
|
| Rate for Payer: United Healthcare HMO Rider |
$96.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC XENON PERFUSION SCAN
|
Facility
IP
|
$1,810.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$1,629.00 |
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.00
|
| Rate for Payer: Galaxy Health WC |
$1,538.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,086.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,629.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,207.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.00
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
| Rate for Payer: Networks By Design Commercial |
$1,176.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,538.50
|
|
|
HC XENON PERFUSION SCAN
|
Facility
OP
|
$1,810.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$1,629.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$911.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,111.28
|
| Rate for Payer: BCBS Transplant Transplant |
$1,086.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,118.58
|
| Rate for Payer: Blue Shield of California EPN |
$879.66
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,448.00
|
| Rate for Payer: Cigna of CA HMO |
$1,158.40
|
| Rate for Payer: Cigna of CA PPO |
$1,339.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| 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 |
$1,538.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,086.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,629.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,357.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,207.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
| Rate for Payer: Networks By Design Commercial |
$1,176.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,538.50
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,086.00
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,086.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,086.00
|
| 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 XPEEDIOR ANGIOJET, CATH
|
Facility
IP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$2,300.40 |
| Rate for Payer: Blue Shield of California EPN |
$1,364.90
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,044.80
|
| Rate for Payer: Cigna of CA HMO |
$1,789.20
|
| Rate for Payer: Cigna of CA PPO |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,300.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,704.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
OP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$5,717.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,717.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,405.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,405.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,167.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,423.69
|
| Rate for Payer: BCBS Transplant Transplant |
$1,533.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,917.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,390.46
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,044.80
|
| Rate for Payer: Cigna of CA HMO |
$1,789.20
|
| Rate for Payer: Cigna of CA PPO |
$1,789.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,300.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,917.00
|
| Rate for Payer: IEHP medi-cal |
$894.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,704.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: Networks By Design Commercial |
$1,278.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: Riverside University Health MISP |
$1,022.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,533.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,533.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,278.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,278.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,172.60
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
IP
|
$962.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Central Health Plan Commercial |
$769.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.80
|
| Rate for Payer: Galaxy Health WC |
$817.70
|
| Rate for Payer: Global Benefits Group Commercial |
$577.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$865.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$641.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.40
|
| Rate for Payer: Multiplan Commercial |
$721.50
|
| Rate for Payer: Networks By Design Commercial |
$625.30
|
| Rate for Payer: Prime Health Services Commercial |
$817.70
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
OP
|
$962.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.41
|
| Rate for Payer: BCBS Transplant Transplant |
$577.20
|
| Rate for Payer: Blue Shield of California Commercial |
$594.52
|
| Rate for Payer: Blue Shield of California EPN |
$467.53
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Central Health Plan Commercial |
$769.60
|
| Rate for Payer: Cigna of CA HMO |
$615.68
|
| Rate for Payer: Cigna of CA PPO |
$711.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| 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 |
$817.70
|
| Rate for Payer: Global Benefits Group Commercial |
$577.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$865.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$721.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$641.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$721.50
|
| Rate for Payer: Networks By Design Commercial |
$625.30
|
| Rate for Payer: Prime Health Services Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$577.20
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.20
|
| 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 ENTIRE SPI 2 OR 3 VIEWS
|
Facility
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,281.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$390.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.89
|
| Rate for Payer: BCBS Transplant Transplant |
$854.40
|
| Rate for Payer: Blue Shield of California Commercial |
$880.03
|
| Rate for Payer: Blue Shield of California EPN |
$692.06
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,139.20
|
| Rate for Payer: Cigna of CA HMO |
$911.36
|
| Rate for Payer: Cigna of CA PPO |
$1,053.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$1,210.40
|
| Rate for Payer: Global Benefits Group Commercial |
$854.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,281.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,068.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$949.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,068.00
|
| Rate for Payer: Networks By Design Commercial |
$925.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,210.40
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$854.40
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$854.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$854.40
|
| 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
|
$1,424.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.80 |
| Max. Negotiated Rate |
$1,281.60 |
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,139.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$569.60
|
| Rate for Payer: Galaxy Health WC |
$1,210.40
|
| Rate for Payer: Global Benefits Group Commercial |
$854.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,281.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$949.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.80
|
| Rate for Payer: Multiplan Commercial |
$1,068.00
|
| Rate for Payer: Networks By Design Commercial |
$925.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,210.40
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,408.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$423.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.63
|
| Rate for Payer: BCBS Transplant Transplant |
$939.00
|
| Rate for Payer: Blue Shield of California Commercial |
$967.17
|
| Rate for Payer: Blue Shield of California EPN |
$760.59
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,408.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,173.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,173.75
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| 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 ENTIRE SPI 4 OR 5 VIEWS
|
Facility
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,408.50 |
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,408.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.00
|
| Rate for Payer: Multiplan Commercial |
$1,173.75
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$508.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.10
|
| Rate for Payer: BCBS Transplant Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,015.99
|
| Rate for Payer: Blue Shield of California EPN |
$798.98
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA HMO |
$1,052.16
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,233.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$986.40
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$986.40
|
| 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: 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
|
$1,644.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
OP
|
$471.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$423.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.68
|
| Rate for Payer: BCBS Transplant Transplant |
$282.60
|
| Rate for Payer: Blue Shield of California Commercial |
$291.08
|
| Rate for Payer: Blue Shield of California EPN |
$228.91
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: Cigna of CA HMO |
$301.44
|
| Rate for Payer: Cigna of CA PPO |
$348.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| 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 |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$353.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$282.60
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.60
|
| 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: 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 1 VIEW
|
Facility
IP
|
$471.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$423.90 |
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.96
|
| Rate for Payer: BCBS Transplant Transplant |
$354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.62
|
| Rate for Payer: Blue Shield of California EPN |
$286.74
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Central Health Plan Commercial |
$472.00
|
| Rate for Payer: Cigna of CA HMO |
$377.60
|
| Rate for Payer: Cigna of CA PPO |
$436.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| 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 |
$501.50
|
| Rate for Payer: Global Benefits Group Commercial |
$354.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$442.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$393.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| Rate for Payer: Networks By Design Commercial |
$383.50
|
| Rate for Payer: Prime Health Services Commercial |
$501.50
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$354.00
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.00
|
| 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: 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
|
$590.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Central Health Plan Commercial |
$472.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.00
|
| Rate for Payer: Galaxy Health WC |
$501.50
|
| Rate for Payer: Global Benefits Group Commercial |
$354.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$393.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| Rate for Payer: Networks By Design Commercial |
$383.50
|
| Rate for Payer: Prime Health Services Commercial |
$501.50
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.40 |
| Max. Negotiated Rate |
$1,050.30 |
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Central Health Plan Commercial |
$933.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.80
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,050.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.40
|
| Rate for Payer: Multiplan Commercial |
$875.25
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
OP
|
$1,167.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,050.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$237.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.10
|
| Rate for Payer: BCBS Transplant Transplant |
$700.20
|
| Rate for Payer: Blue Shield of California Commercial |
$721.21
|
| Rate for Payer: Blue Shield of California EPN |
$567.16
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Central Health Plan Commercial |
$933.60
|
| Rate for Payer: Cigna of CA HMO |
$746.88
|
| Rate for Payer: Cigna of CA PPO |
$863.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,050.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$875.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$875.25
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$700.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$700.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$700.20
|
| 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
|
$1,303.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,172.70 |
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,042.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,172.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.60
|
| Rate for Payer: Multiplan Commercial |
$977.25
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,172.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.13
|
| Rate for Payer: BCBS Transplant Transplant |
$781.80
|
| Rate for Payer: Blue Shield of California Commercial |
$805.25
|
| Rate for Payer: Blue Shield of California EPN |
$633.26
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,042.40
|
| Rate for Payer: Cigna of CA HMO |
$833.92
|
| Rate for Payer: Cigna of CA PPO |
$964.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,172.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$977.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$977.25
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$781.80
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$781.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$781.80
|
| 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 HIP W/PELVIS BI 5/GT VIEWS
|
Facility
IP
|
$1,368.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,094.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.20
|
| Rate for Payer: Galaxy Health WC |
$1,162.80
|
| Rate for Payer: Global Benefits Group Commercial |
$820.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,231.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$912.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$1,026.00
|
| Rate for Payer: Networks By Design Commercial |
$889.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,162.80
|
|
