|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,646.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,027.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.51
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,175.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,380.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,183.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,183.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,278.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.00
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$923.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$846.29
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$394.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.64
|
| Rate for Payer: Blue Shield of California Commercial |
$142.85
|
| Rate for Payer: Blue Shield of California EPN |
$114.87
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$304.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.87
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.20
|
| Rate for Payer: Blue Shield of California Commercial |
$260.02
|
| Rate for Payer: Blue Shield of California EPN |
$209.10
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$429.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.17 |
| Max. Negotiated Rate |
$1,098.75 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$943.46
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.80
|
| Rate for Payer: Heritage Provider Network Senior |
$991.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.25
|
| Rate for Payer: Multiplan Commercial |
$1,098.75
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,098.75 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$905.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.80
|
| Rate for Payer: Blue Shield of California Commercial |
$282.19
|
| Rate for Payer: Blue Shield of California EPN |
$226.93
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$952.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$906.84
|
| Rate for Payer: Heritage Provider Network Senior |
$906.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$698.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,098.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.32 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,175.30
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,235.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,235.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.25
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
|
|
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 |
$134.46 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,127.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$663.51
|
| Rate for Payer: Blue Shield of California Commercial |
$338.78
|
| Rate for Payer: Blue Shield of California EPN |
$272.44
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,186.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,076.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,129.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,129.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$870.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.65
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.52
|
| Rate for Payer: Blue Shield of California Commercial |
$108.48
|
| Rate for Payer: Blue Shield of California EPN |
$87.24
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Senior |
$273.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$210.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$491.25 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$404.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.41
|
| Rate for Payer: Blue Shield of California Commercial |
$128.69
|
| Rate for Payer: Blue Shield of California EPN |
$103.49
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$425.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.44
|
| Rate for Payer: Heritage Provider Network Senior |
$405.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$312.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$491.25 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$443.44
|
| Rate for Payer: Heritage Provider Network Senior |
$443.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.75
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$604.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.41
|
| Rate for Payer: Blue Shield of California Commercial |
$158.98
|
| Rate for Payer: Blue Shield of California EPN |
$127.84
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$635.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$577.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$605.38
|
| Rate for Payer: Heritage Provider Network Senior |
$605.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$466.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$733.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.83
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.11
|
| Rate for Payer: Heritage Provider Network Senior |
$662.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.50
|
| Rate for Payer: Multiplan Commercial |
$733.50
|
|
|
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 |
$134.46 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.36
|
| Rate for Payer: Blue Shield of California Commercial |
$189.31
|
| Rate for Payer: Blue Shield of California EPN |
$152.24
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$939.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$853.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$895.07
|
| Rate for Payer: Heritage Provider Network Senior |
$895.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$689.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
IP
|
$1,446.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$261.73 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$931.22
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$978.94
|
| Rate for Payer: Heritage Provider Network Senior |
$978.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.50
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
|
|
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 |
$274.94 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Adventist Health Commercial |
$303.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.24
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,028.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,028.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.75
|
| Rate for Payer: Multiplan Commercial |
$1,139.25
|
|
|
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 |
$134.46 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Adventist Health Commercial |
$303.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$938.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.66
|
| Rate for Payer: Blue Shield of California Commercial |
$227.66
|
| Rate for Payer: Blue Shield of California EPN |
$183.08
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$987.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$940.26
|
| Rate for Payer: Heritage Provider Network Senior |
$940.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$724.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,139.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.57 |
| Max. Negotiated Rate |
$474.75 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.65
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$428.54
|
| Rate for Payer: Heritage Provider Network Senior |
$428.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.25
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.14 |
| Max. Negotiated Rate |
$474.75 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.28
|
| Rate for Payer: Blue Shield of California Commercial |
$114.58
|
| Rate for Payer: Blue Shield of California EPN |
$92.14
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$411.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.83
|
| Rate for Payer: Heritage Provider Network Senior |
$391.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$301.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$663.75 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.41
|
| Rate for Payer: Blue Shield of California Commercial |
$169.10
|
| Rate for Payer: Blue Shield of California EPN |
$135.99
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$575.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.82
|
| Rate for Payer: Heritage Provider Network Senior |
$547.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$422.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.19 |
| Max. Negotiated Rate |
$663.75 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$569.94
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.14
|
| Rate for Payer: Heritage Provider Network Senior |
$599.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
|
|
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 |
$134.46 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Adventist Health Commercial |
$273.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$843.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$409.36
|
| Rate for Payer: Blue Shield of California Commercial |
$209.52
|
| Rate for Payer: Blue Shield of California EPN |
$168.49
|
| Rate for Payer: Cash Price |
$614.25
|
| Rate for Payer: Cash Price |
$614.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$887.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$805.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$844.93
|
| Rate for Payer: Heritage Provider Network Senior |
$844.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$651.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$247.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,023.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.06 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Adventist Health Commercial |
$273.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$879.06
|
| Rate for Payer: Cash Price |
$614.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$924.11
|
| Rate for Payer: Heritage Provider Network Senior |
$924.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$247.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.25
|
| Rate for Payer: Multiplan Commercial |
$1,023.75
|
|
