▸ Hospital · CA · CCN 050099
San Antonio Regional Hospital
999 SAN BERNARDINO ROAD, UPLAND, CA, 91786
363 bedsAcute Care Hospitals2
Compliance grade
A
100/100
Procedures tracked
136
of 209 target codes
Payers
11
with negotiated rates
Rates published
12,944
last crawl 2026-05-22
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 10 | — | — | $3,220.71 | $12,244 | $28,908 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 11 | $112 | $67.2 | $20 | $75.93 | $476.21 |
| ED visit level 2 | CPT | 99282 | 11 | $264 | $158.4 | $32.17 | $136.55 | $856.48 |
| ED visit level 3 | CPT | 99283 | 11 | $508 | $304.8 | $97.75 | $238.76 | $1,497.55 |
| ED visit level 4 | CPT | 99284 | 11 | $3,195 | $1,917 | $93.17 | $367.19 | $2,811.6 |
| ED visit level 5 | CPT | 99285 | 11 | $5,451 | $3,270.6 | $135.11 | $1,606.07 | $4,796.88 |
| Critical care, first hour | CPT | 99291 | 2 | $467 | $280.2 | $162.39 | $178.71 | $195.02 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 11 | $2,603 | $1,561.8 | $30.11 | $91.7 | $2,290.64 |
| CT head with contrast | CPT | 70460 | 11 | $2,850 | $1,710 | $39.89 | $153.51 | $2,508 |
| CT head with and without contrast | CPT | 70470 | 11 | $4,047 | $2,428.2 | $45.03 | $153.51 | $3,561.36 |
| CT neck with contrast | CPT | 70491 | 11 | $3,333 | $1,999.8 | $48.64 | $153.51 | $2,933.04 |
| MRI brain without contrast | CPT | 70551 | 11 | $5,406 | $3,243.6 | $52.25 | $208.44 | $4,757.28 |
| MRI brain with contrast | CPT | 70552 | 11 | $6,083 | $3,649.8 | $63.05 | $307.95 | $5,353.04 |
| MRI brain with and without contrast | CPT | 70553 | 11 | $7,774 | $4,664.4 | $81.59 | $307.95 | $6,841.12 |
| Chest X-ray single view | CPT | 71045 | 11 | $373 | $223.8 | $6.44 | $75.93 | $476.21 |
| Chest X-ray 2 views | CPT | 71046 | 11 | $443 | $265.8 | $7.72 | $75.93 | $476.21 |
| Chest X-ray 3 views | CPT | 71047 | 11 | $568 | $340.8 | $75.93 | $75.93 | $499.84 |
| CT chest without contrast | CPT | 71250 | 11 | $3,199 | $1,919.4 | $38.35 | $91.7 | $2,815.12 |
| CT chest with contrast | CPT | 71260 | 11 | $4,380 | $2,628 | $41.18 | $153.51 | $3,854.4 |
| CT chest with and without contrast | CPT | 71270 | 11 | $5,235 | $3,141 | $153.51 | $153.51 | $4,606.8 |
| MRI chest without contrast | CPT | 71550 | 11 | $5,406 | $3,243.6 | $208.44 | $208.44 | $4,757.28 |
| MRI chest with contrast | CPT | 71551 | 11 | $5,406 | $3,243.6 | $681.27 | $681.27 | $4,757.28 |
| Lumbosacral spine X-ray | CPT | 72100 | 11 | $467 | $280.2 | $7.98 | $91.7 | $575.14 |
| CT cervical spine without contrast | CPT | 72125 | 11 | $3,556 | $2,133.6 | $35 | $91.7 | $3,129.28 |
| CT thoracic spine without contrast | CPT | 72128 | 11 | $3,629 | $2,177.4 | $35 | $91.7 | $3,193.52 |
| CT lumbar spine without contrast | CPT | 72131 | 11 | $2,983 | $1,789.8 | $35 | $91.7 | $2,625.04 |
| MRI cervical spine without contrast | CPT | 72141 | 11 | $5,101 | $3,060.6 | $52.5 | $208.44 | $4,488.88 |
| MRI thoracic spine without contrast | CPT | 72146 | 11 | $5,406 | $3,243.6 | $208.44 | $208.44 | $4,757.28 |
| MRI lumbar spine without contrast | CPT | 72148 | 11 | $5,492 | $3,295.2 | $52.5 | $208.44 | $4,832.96 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 11 | $5,641 | $3,384.6 | $307.95 | $307.95 | $4,964.08 |
| MRI cervical spine with and without contrast | CPT | 72156 | 11 | $8,211 | $4,926.6 | $81.84 | $307.95 | $7,225.68 |
| MRI lumbar spine with contrast | CPT | 72158 | 11 | $6,753 | $4,051.8 | $81.84 | $307.95 | $5,942.64 |
| CT pelvis without contrast | CPT | 72192 | 11 | $3,069 | $1,841.4 | $38.61 | $91.7 | $2,700.72 |
| CT pelvis with contrast | CPT | 72193 | 11 | $4,257 | $2,554.2 | $153.51 | $153.51 | $3,746.16 |
| Shoulder X-ray | CPT | 73030 | 11 | $811 | $486.6 | $6.69 | $197.94 | $713.68 |
| Humerus X-ray | CPT | 73060 | 11 | $811 | $486.6 | $5.66 | $197.94 | $713.68 |
| Hand X-ray 3 views | CPT | 73130 | 11 | $813 | $487.8 | $6.17 | $198.33 | $715.44 |
| MRI upper extremity joint without contrast | CPT | 73221 | 11 | $5,406 | $3,243.6 | $47.87 | $208.44 | $4,757.28 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 11 | $5,305 | $3,183 | $307.95 | $307.95 | $4,668.4 |
| Knee X-ray 1-2 views | CPT | 73560 | 11 | $764 | $458.4 | $5.92 | $188.85 | $672.32 |
| Ankle X-ray 3 views | CPT | 73610 | 11 | $886 | $531.6 | $6.17 | $212.95 | $779.68 |
| MRI lower extremity joint without contrast | CPT | 73721 | 11 | $10,204 | $6,122.4 | $47.87 | $625.24 | $8,979.52 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 11 | $5,406 | $3,243.6 | $307.95 | $307.95 | $4,757.28 |
| CT abdomen without contrast | CPT | 74150 | 11 | $2,772 | $1,663.2 | $41.95 | $91.7 | $2,439.36 |
| CT abdomen with contrast | CPT | 74160 | 11 | $3,414 | $2,048.4 | $153.51 | $153.51 | $3,004.32 |
| CT abdomen with and without contrast | CPT | 74170 | 11 | $4,078 | $2,446.8 | $47.87 | $153.51 | $3,588.64 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 11 | $5,840 | $3,504 | $61.51 | $208.44 | $5,139.2 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 11 | $7,668 | $4,600.8 | $64.86 | $307.95 | $6,747.84 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 11 | $8,937 | $5,362.2 | $71.03 | $307.95 | $7,864.56 |
| MRI abdomen without contrast | CPT | 74181 | 11 | $4,254 | $2,552.4 | $51.47 | $208.44 | $3,743.52 |
| MRI abdomen with and without contrast | CPT | 74183 | 11 | $4,508 | $2,704.8 | $78.24 | $307.95 | $3,967.04 |
| Abdominal ultrasound complete | CPT | 76700 | 11 | $1,555 | $933 | $28.57 | $91.7 | $1,368.4 |
| Abdominal ultrasound limited | CPT | 76705 | 11 | $942 | $565.2 | $20.84 | $91.7 | $828.96 |
| Obstetric ultrasound first trimester | CPT | 76801 | 11 | $1,473 | $883.8 | $91.7 | $91.7 | $1,296.24 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 2 | $166 | $99.6 | $35.26 | $40.49 | $45.73 |
| Transvaginal ultrasound | CPT | 76830 | 11 | $1,473 | $883.8 | $91.7 | $91.7 | $1,296.24 |
| Pelvic ultrasound complete | CPT | 76856 | 11 | $1,298 | $778.8 | $24.44 | $91.7 | $1,142.24 |
| Scrotal ultrasound | CPT | 76870 | 11 | $1,473 | $883.8 | $22.65 | $91.7 | $1,296.24 |
| Diagnostic mammography unilateral | CPT | 77065 | 11 | $792 | $475.2 | $28.57 | $76.62 | $696.96 |
| Diagnostic mammography bilateral | CPT | 77066 | 11 | $792 | $475.2 | $98.3 | $98.3 | $696.96 |
| Screening mammography bilateral | CPT | 77067 | 11 | $331 | $198.6 | $27.03 | $81.07 | $508.48 |
| EKG complete | CPT | 93000 | 4 | $239 | $143.4 | $188.81 | $194.79 | $210.32 |
| EKG tracing only | CPT | 93005 | 11 | $391 | $234.6 | $51.22 | $84.53 | $344.08 |
| EKG interpretation only | CPT | 93010 | 5 | $87 | $52.2 | $5.92 | $38.42 | $76.56 |
| Transthoracic echocardiogram complete | CPT | 93306 | 11 | $4,400 | $2,640 | $50.44 | $472.8 | $3,872 |
| Transthoracic echocardiogram | CPT | 93307 | 2 | $236.5 | $141.9 | $31.91 | $36.89 | $41.88 |
| inpatient | ||||||||
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 10 | — | — | $7,843.45 | $13,698 | $32,342 |
| COPD w MCC | MS-DRG | 190 | 10 | — | — | $6,304.67 | $9,709.73 | $22,925 |
| COPD w CC | MS-DRG | 191 | 10 | — | — | $5,264.02 | $7,389.46 | $17,447 |
| COPD w/o CC/MCC | MS-DRG | 192 | 10 | — | — | $3,520.86 | $5,627.56 | $13,287 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 10 | — | — | $4,737.26 | $7,064.25 | $16,679 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 10 | — | — | $2,837.13 | $5,509.22 | $13,007 |
| AMI discharged alive w MCC | MS-DRG | 280 | 10 | — | — | $8,801.67 | $14,061 | $33,198 |
| AMI discharged alive w CC | MS-DRG | 281 | 10 | — | — | $6,384.65 | $8,056.53 | $19,022 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 10 | — | — | $6,033.15 | $6,338.46 | $14,965 |
| Heart failure & shock w MCC | MS-DRG | 291 | 10 | — | — | $6,861.54 | $11,253 | $26,570 |
| Heart failure & shock w CC | MS-DRG | 292 | 10 | — | — | $6,004.03 | $7,442.05 | $17,571 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 10 | — | — | $7,584.27 | $10,554 | $24,918 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 10 | — | — | $4,651.37 | $6,448.9 | $15,226 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 10 | — | — | $3,226.64 | $4,962.25 | $11,716 |
| GI hemorrhage w CC | MS-DRG | 378 | 10 | — | — | $6,310.59 | $8,596.49 | $20,297 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 10 | — | — | $4,166.1 | $5,525.88 | $13,047 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 10 | — | — | $4,323.08 | $6,833.72 | $16,135 |
| Kidney/UTI w MCC | MS-DRG | 689 | 10 | — | — | $6,318.01 | $10,171 | $24,014 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 10 | — | — | $4,016.02 | $7,095.81 | $16,753 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 10 | — | — | $10,361 | $17,027 | $40,202 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 10 | — | — | $5,597.25 | $8,969.91 | $21,178 |
| Initial hospital care, low complexity | CPT | 99221 | 2 | $162 | $97.2 | $62.54 | $67.66 | $72.79 |
| Initial hospital care, moderate complexity | CPT | 99222 | 2 | $222 | $133.2 | $97.8 | $106.06 | $114.33 |
| Initial hospital care, high complexity | CPT | 99223 | 2 | $321 | $192.6 | $130.48 | $141.71 | $152.94 |
| Hospital discharge, <30 min | CPT | 99238 | 2 | $152 | $91.2 | $60.48 | $66.51 | $72.54 |
| Hospital discharge, >30 min | CPT | 99239 | 2 | $198 | $118.8 | $85.44 | $94.39 | $103.34 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 11 | $240 | $144 | $7.61 | $8.46 | $211.2 |
| Electrolyte panel | CPT | 80051 | 11 | $192 | $115.2 | $6.31 | $7.01 | $168.96 |
| Comprehensive metabolic panel | CPT | 80053 | 11 | $285 | $171 | $9.5 | $10.56 | $250.8 |
| Lipid panel | CPT | 80061 | 11 | $398 | $238.8 | $12.05 | $13.39 | $350.24 |
| Renal function panel | CPT | 80069 | 11 | $351 | $210.6 | $7.81 | $8.68 | $308.88 |
| Hepatic function panel | CPT | 80076 | 11 | $310 | $186 | $7.35 | $8.17 | $272.8 |
| Urinalysis non-automated | CPT | 81002 | 11 | $60 | $36 | $3.13 | $17.4 | $52.8 |
| Urinalysis automated | CPT | 81003 | 11 | $60 | $36 | $2.03 | $11.25 | $52.8 |
| Glucose quantitative | CPT | 82947 | 11 | $204 | $122.4 | $3.54 | $3.93 | $179.52 |
| Hemoglobin A1c | CPT | 83036 | 11 | $134 | $80.4 | $8.74 | $19.75 | $117.92 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 11 | $302 | $181.2 | $15.12 | $16.8 | $265.76 |
| Complete blood count with automated differential | CPT | 85025 | 11 | $181 | $108.6 | $6.99 | $7.77 | $159.28 |
| Complete blood count without differential | CPT | 85027 | 11 | $103 | $61.8 | $5.82 | $6.47 | $90.64 |
| Urine culture bacterial | CPT | 87086 | 11 | $212 | $127.2 | $7.26 | $8.07 | $186.56 |
| Tissue exam by pathologist level IV | CPT | 88305 | 11 | $161 | $96.6 | $22.55 | $46.07 | $288.97 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 5 | $151 | $90.6 | $35 | $60.04 | $68.64 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 5 | $298 | $178.8 | $61.76 | $87.21 | $262.24 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 5 | $341 | $204.6 | $100.62 | $129.06 | $160.16 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 5 | $421 | $252.6 | $136.91 | $170.73 | $205.92 |
| Office visit, established patient, 5 min | CPT | 99211 | 4 | $689 | $413.4 | $45.03 | $180.85 | $606.32 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 5 | $123 | $73.8 | $26.51 | $60.04 | $68.64 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 5 | $227 | $136.2 | $56.25 | $65.13 | $199.76 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 5 | $226 | $135.6 | $73.09 | $84.45 | $95.92 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 5 | $333 | $199.8 | $107.57 | $122.24 | $135.52 |
| surgery | ||||||||
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 10 | — | — | $21,707 | $40,291 | $95,129 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 10 | — | — | $16,246 | $21,013 | $49,612 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 10 | — | — | $12,765 | $14,752 | $34,829 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 10 | — | — | $10,314 | $14,828 | $35,009 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 10 | — | — | $8,912.24 | $11,972 | $28,267 |
| Major joint replacement w MCC | MS-DRG | 469 | 10 | — | — | $15,267 | $26,588 | $62,775 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 10 | — | — | $10,225 | $16,908 | $39,921 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 10 | — | — | $17,080 | $25,528 | $60,273 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 10 | — | — | $13,589 | $18,360 | $43,348 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 10 | — | — | $9,830.97 | $14,297 | $33,755 |
| Total abdominal hysterectomy | CPT | 58150 | 2 | $3,290 | $1,974 | $777.72 | $838.68 | $899.64 |
| Vaginal hysterectomy | CPT | 58260 | 2 | $3,363 | $2,017.8 | $639.01 | $677.65 | $716.29 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 2 | $3,632 | $2,179.2 | $674.02 | $716.96 | $759.9 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 2 | $3,460 | $2,076 | $749.93 | $798.97 | $848.01 |
| Lap salpingo-oophorectomy | CPT | 58661 | 2 | $2,523 | $1,513.8 | $282.06 | $424.44 | $566.82 |
| PCI single major coronary artery | CPT | 92920 | 11 | $16,052 | $9,631.2 | $377.86 | $4,916.44 | $30,836 |
| PCI with drug-eluting stent | CPT | 92928 | 11 | $24,374 | $14,624 | $450.63 | $9,779.02 | $61,335 |
| PCI bypass graft | CPT | 92937 | 11 | $24,374 | $14,624 | $450.38 | $9,779.02 | $61,335 |
| Coronary angiography with cath | CPT | 93455 | 11 | $19,259 | $11,555 | $211.29 | $2,773.52 | $17,396 |
| Coronary angiography with bypass cath | CPT | 93458 | 11 | $27,873 | $16,724 | $222.87 | $2,773.52 | $24,528 |
Payer mix (top 11)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 136 | $208.44 |
| the health plan | 134 | $100.62 |
| umr | 123 | $2,524.05 |
| UnitedHealthcare | 123 | $625.68 |
| optum ccn region 1 | 112 | $208.44 |
| optum ccn region 2 | 112 | $208.44 |
| WellCare | 112 | $208.44 |
| Anthem BCBS | 112 | $208.44 |
| Blue Cross Blue Shield | 112 | $1,250.49 |
| Humana | 112 | $208.44 |
| the health plan hmo | 91 | $681.24 |