|
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 |
$85.96 |
| Max. Negotiated Rate |
$1,563.30 |
| Rate for Payer: Adventist Health Commercial |
$347.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,054.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$423.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,054.36
|
| Rate for Payer: Blue Shield of California EPN |
$689.59
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Cash Price |
$955.35
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,476.45
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,476.45
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
IP
|
$1,737.00
|
|
|
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 |
$955.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,389.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,075.20
|
| 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
|
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 |
$1,003.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,460.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,129.67
|
| 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 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 |
$103.18 |
| Max. Negotiated Rate |
$1,642.50 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,108.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$508.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,107.78
|
| Rate for Payer: Blue Shield of California EPN |
$724.52
|
| Rate for Payer: Cash Price |
$1,003.75
|
| Rate for Payer: Cash Price |
$1,003.75
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.89 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.89
|
| Rate for Payer: Blue Shield of California Commercial |
$317.46
|
| Rate for Payer: Blue Shield of California EPN |
$207.63
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Cash Price |
$287.65
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| 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 |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY FEMUR 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 |
$287.65
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| 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 Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.74
|
| 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 |
$360.25
|
| Rate for Payer: Central Health Plan Commercial |
$524.00
|
| 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 Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| 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 |
$39.09 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$397.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.09
|
| Rate for Payer: Blue Shield of California Commercial |
$397.58
|
| Rate for Payer: Blue Shield of California EPN |
$260.04
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| 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 |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
IP
|
$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 |
$712.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.80
|
| 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 Permanente of CA Commercial/Self Funded |
$864.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.22
|
| 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 2 VIEWS
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.27 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Adventist Health Commercial |
$259.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$787.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$237.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.27
|
| Rate for Payer: Blue Shield of California Commercial |
$786.67
|
| Rate for Payer: Blue Shield of California EPN |
$514.51
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$864.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
OP
|
$1,446.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$1,301.40 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$878.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$877.72
|
| Rate for Payer: Blue Shield of California EPN |
$574.06
|
| Rate for Payer: Cash Price |
$795.30
|
| Rate for Payer: Cash Price |
$795.30
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,229.10
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$964.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,229.10
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
IP
|
$1,446.00
|
|
|
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 |
$795.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,156.80
|
| 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 Permanente of CA Commercial/Self Funded |
$964.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$895.07
|
| 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 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 |
$835.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,215.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,013.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$578.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$940.26
|
| 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 BI 5/GT VIEWS
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$1,367.10 |
| Rate for Payer: Adventist Health Commercial |
$303.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$922.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$341.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.30
|
| Rate for Payer: Blue Shield of California Commercial |
$922.03
|
| Rate for Payer: Blue Shield of California EPN |
$603.04
|
| Rate for Payer: Cash Price |
$835.45
|
| Rate for Payer: Cash Price |
$835.45
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,291.15
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,013.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,291.15
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS UNI 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 |
$437.80
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| 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 Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| 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 |
$34.72 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$483.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$171.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.72
|
| Rate for Payer: Blue Shield of California Commercial |
$483.17
|
| Rate for Payer: Blue Shield of California EPN |
$316.01
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| 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 |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
IP
|
$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 |
$608.30
|
| Rate for Payer: Central Health Plan Commercial |
$884.80
|
| 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 Permanente of CA Commercial/Self Funded |
$737.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$684.61
|
| 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 |
$51.38 |
| Max. Negotiated Rate |
$995.40 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$671.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$253.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.38
|
| Rate for Payer: Blue Shield of California Commercial |
$671.34
|
| Rate for Payer: Blue Shield of California EPN |
$439.08
|
| Rate for Payer: Cash Price |
$608.30
|
| Rate for Payer: Cash Price |
$608.30
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| 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 |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
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 |
$750.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,092.00
|
| 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 Permanente of CA Commercial/Self Funded |
$910.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$844.93
|
| 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 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 |
$63.66 |
| Max. Negotiated Rate |
$1,228.50 |
| Rate for Payer: Adventist Health Commercial |
$273.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$828.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.66
|
| Rate for Payer: Blue Shield of California Commercial |
$828.55
|
| Rate for Payer: Blue Shield of California EPN |
$541.90
|
| Rate for Payer: Cash Price |
$750.75
|
| Rate for Payer: Cash Price |
$750.75
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,160.25
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$910.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.26
|
| Rate for Payer: Blue Shield of California Commercial |
$712.01
|
| Rate for Payer: Blue Shield of California EPN |
$465.68
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$750.72
|
| Rate for Payer: Cigna of CA PPO |
$868.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$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: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| 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 Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| 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
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$238.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$722.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.44
|
| Rate for Payer: Blue Shield of California Commercial |
$722.33
|
| Rate for Payer: Blue Shield of California EPN |
$472.43
|
| Rate for Payer: Cash Price |
$654.50
|
| Rate for Payer: Cash Price |
$654.50
|
| Rate for Payer: Central Health Plan Commercial |
$952.00
|
| Rate for Payer: Cigna of CA HMO |
$761.60
|
| Rate for Payer: Cigna of CA PPO |
$880.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,011.50
|
| Rate for Payer: Global Benefits Group Commercial |
$714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$892.50
|
| Rate for Payer: Networks By Design Commercial |
$773.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,011.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$238.00
|
| Rate for Payer: Cash Price |
$654.50
|
| Rate for Payer: Central Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$476.00
|
| Rate for Payer: Galaxy Health WC |
$1,011.50
|
| Rate for Payer: Global Benefits Group Commercial |
$714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$736.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Multiplan Commercial |
$892.50
|
| Rate for Payer: Networks By Design Commercial |
$773.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,011.50
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
IP
|
$1,514.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.80 |
| Max. Negotiated Rate |
$1,362.60 |
| Rate for Payer: Adventist Health Commercial |
$302.80
|
| Rate for Payer: Cash Price |
$832.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.60
|
| Rate for Payer: EPIC Health Plan Senior |
$605.60
|
| Rate for Payer: Galaxy Health WC |
$1,286.90
|
| Rate for Payer: Global Benefits Group Commercial |
$908.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,362.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$937.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.80
|
| Rate for Payer: Multiplan Commercial |
$1,135.50
|
| Rate for Payer: Networks By Design Commercial |
$984.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.90
|
|
