▸ Hospital · CA · CCN 050758
Montclair Hospital Medical Center
5000 SAN BERNARDINO, MONTCLAIR, CA, 91763
106 bedsAcute Care Hospitals4
Compliance grade
A
100/100
Procedures tracked
145
of 209 target codes
Payers
26
with negotiated rates
Rates published
6,331
last crawl 2026-05-22
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 20 | — | $14,084 | $6,518.71 | $14,085 | $28,170 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 24 | $754.88 | $107 | $21.77 | $107.92 | $215.84 |
| ED visit level 2 | CPT | 99282 | 24 | $1,290.44 | $196 | $34.97 | $196.51 | $393.02 |
| ED visit level 3 | CPT | 99283 | 24 | $2,284.44 | $349 | $51 | $349.37 | $698.74 |
| ED visit level 4 | CPT | 99284 | 24 | $3,409.93 | $534 | $51 | $534.03 | $1,068.06 |
| ED visit level 5 | CPT | 99285 | 24 | $5,058.67 | $762 | $51 | $762.2 | $1,524.4 |
| Critical care, first hour | CPT | 99291 | 24 | $7,580.38 | $1,057 | $51 | $1,057.2 | $2,114.4 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 24 | $6,964.38 | $133 | $94.42 | $133.8 | $296.47 |
| CT head with contrast | CPT | 70460 | 24 | $3,855.5 | $224 | $137.27 | $224.48 | $448.96 |
| CT head with and without contrast | CPT | 70470 | 24 | $5,598.75 | $224 | $163.9 | $224.48 | $448.96 |
| CT neck with contrast | CPT | 70491 | 24 | $4,639.75 | $224 | $184.4 | $224.48 | $448.96 |
| MRI brain without contrast | CPT | 70551 | 24 | $5,922.5 | $305 | $188.21 | $305.38 | $767.79 |
| MRI brain with contrast | CPT | 70552 | 24 | $2,151.33 | $446 | $276.68 | $446.5 | $926.42 |
| MRI brain with and without contrast | CPT | 70553 | 24 | $8,453.75 | $446 | $316.79 | $446.5 | $1,435.35 |
| Chest X-ray single view | CPT | 71045 | 24 | $745.25 | $111 | $9.71 | $111.37 | $222.74 |
| Chest X-ray 2 views | CPT | 71046 | 24 | $1,036.75 | $111 | $18.13 | $111.37 | $222.74 |
| CT chest without contrast | CPT | 71250 | 24 | $6,179.25 | $133 | $127.11 | $133.8 | $350.49 |
| CT chest with contrast | CPT | 71260 | 24 | $5,910.7 | $224 | $170.83 | $224.48 | $448.96 |
| CT chest with and without contrast | CPT | 71270 | 24 | $5,614.11 | $224 | $208.88 | $224.48 | $448.96 |
| MRI chest without contrast | CPT | 71550 | 24 | $5,103 | $305 | $290.11 | $305.38 | $867.15 |
| MRI chest with and without contrast | CPT | 71552 | 24 | $3,491.88 | $446 | $387.38 | $446.5 | $893 |
| Lumbosacral spine X-ray | CPT | 72100 | 24 | $1,105.02 | $133 | $29.98 | $133.8 | $267.6 |
| CT cervical spine without contrast | CPT | 72125 | 24 | $5,885 | $133 | $127.11 | $133.8 | $350.49 |
| CT thoracic spine without contrast | CPT | 72128 | 24 | $5,260 | $133 | $127.11 | $133.8 | $350.49 |
| CT lumbar spine without contrast | CPT | 72131 | 24 | $5,260 | $133 | $127.11 | $133.8 | $350.49 |
| MRI cervical spine without contrast | CPT | 72141 | 24 | $6,197.5 | $305 | $181.08 | $305.38 | $867.15 |
| MRI thoracic spine without contrast | CPT | 72146 | 24 | $6,197.5 | $305 | $183.45 | $305.38 | $867.15 |
| MRI lumbar spine without contrast | CPT | 72148 | 24 | $6,378.75 | $305 | $181.42 | $305.38 | $867.15 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 24 | $1,785.65 | $446 | $281.85 | $446.5 | $1,027.55 |
| MRI cervical spine with and without contrast | CPT | 72156 | 24 | $6,821.37 | $446 | $319.01 | $446.5 | $1,462.81 |
| MRI lumbar spine with contrast | CPT | 72158 | 24 | $8,359.59 | $446 | $318.04 | $446.5 | $1,461.3 |
| CT pelvis without contrast | CPT | 72192 | 24 | $5,617.5 | $133 | $117.13 | $133.8 | $350.49 |
| CT pelvis with contrast | CPT | 72193 | 24 | $4,823.75 | $224 | $213.26 | $224.48 | $448.96 |
| Shoulder X-ray | CPT | 73030 | 24 | $1,068.38 | $111 | $25.59 | $111.37 | $222.74 |
| Humerus X-ray | CPT | 73060 | 24 | $882.06 | $111 | $21.46 | $111.37 | $222.74 |
| Hand X-ray 3 views | CPT | 73130 | 24 | $1,092.15 | $111 | $26.32 | $111.37 | $222.74 |
| MRI upper extremity joint without contrast | CPT | 73221 | 24 | $6,378.75 | $305 | $206.55 | $305.38 | $610.76 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 24 | $1,785.65 | $446 | $301.18 | $446.5 | $893 |
| Knee X-ray 1-2 views | CPT | 73560 | 24 | $838.24 | $111 | $20.19 | $111.37 | $222.74 |
| Ankle X-ray 3 views | CPT | 73610 | 24 | $948.44 | $111 | $26.32 | $111.37 | $222.74 |
| MRI lower extremity joint without contrast | CPT | 73721 | 24 | $6,378.75 | $305 | $206.2 | $305.38 | $610.76 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 24 | $3,491.88 | $446 | $300.2 | $446.5 | $893 |
| CT abdomen without contrast | CPT | 74150 | 24 | $6,743 | $133 | $116.66 | $133.8 | $350.49 |
| CT abdomen with contrast | CPT | 74160 | 24 | $5,759.3 | $224 | $213.26 | $224.48 | $448.96 |
| CT abdomen with and without contrast | CPT | 74170 | 24 | $6,717.5 | $224 | $213.26 | $224.48 | $448.96 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 24 | $7,926.11 | $305 | $51 | $305.38 | $610.76 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 24 | $9,567.25 | $446 | $51 | $446.5 | $893 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 24 | $10,298 | $446 | $233.05 | $446.5 | $893 |
| MRI abdomen without contrast | CPT | 74181 | 24 | $5,095 | $305 | $216.39 | $305.38 | $846.78 |
| MRI abdomen with and without contrast | CPT | 74183 | 24 | $6,358.26 | $446 | $263.48 | $446.5 | $893 |
| Abdominal ultrasound complete | CPT | 76700 | 24 | $2,556.13 | $133 | $82.35 | $133.8 | $267.6 |
| Abdominal ultrasound limited | CPT | 76705 | 24 | $2,051.09 | $133 | $51 | $133.8 | $267.6 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 24 | $2,103.49 | $133 | $79.89 | $133.8 | $267.6 |
| Obstetric ultrasound first trimester | CPT | 76801 | 24 | $1,235 | $133 | $47.84 | $133.8 | $267.6 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 24 | $1,479 | $133 | $90.65 | $133.8 | $267.6 |
| Transvaginal ultrasound | CPT | 76830 | 24 | $1,535 | $133 | $70.84 | $133.8 | $267.6 |
| Pelvic ultrasound complete | CPT | 76856 | 24 | $2,142.15 | $133 | $67.93 | $133.8 | $267.6 |
| Scrotal ultrasound | CPT | 76870 | 24 | $1,599.75 | $133 | $47.16 | $133.8 | $267.6 |
| Diagnostic mammography unilateral | CPT | 77065 | 24 | $844.9 | $94 | $84.3 | $94.37 | $188.74 |
| Diagnostic mammography bilateral | CPT | 77066 | 24 | $1,060 | $121 | $108.06 | $121.01 | $242.02 |
| Screening mammography bilateral | CPT | 77067 | 24 | $589.51 | $99 | $88.39 | $99.86 | $199.72 |
| EKG tracing only | CPT | 93005 | 24 | $699.88 | $75 | $23.52 | $75.5 | $151 |
| Transthoracic echocardiogram complete | CPT | 93306 | 24 | $4,329.67 | $699 | $177.42 | $699.34 | $1,398.68 |
| Transthoracic echocardiogram | CPT | 93307 | 24 | $2,600.03 | $305 | $129.18 | $305.38 | $610.76 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 20 | — | $20,002 | $19,878 | $20,003 | $40,006 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 20 | — | $10,361 | $10,298 | $10,361 | $20,722 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 20 | — | $7,220 | $7,178.47 | $7,220.9 | $14,442 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 20 | — | $15,683 | $15,587 | $15,683 | $31,367 |
| COPD w MCC | MS-DRG | 190 | 20 | — | $11,299 | $11,065 | $11,299 | $22,599 |
| COPD w CC | MS-DRG | 191 | 20 | — | $8,749 | $8,696.77 | $8,749.04 | $17,498 |
| COPD w/o CC/MCC | MS-DRG | 192 | 20 | — | $6,812 | $6,135.19 | $6,812.37 | $13,625 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 20 | — | $8,391 | $8,341.61 | $8,391.58 | $16,783 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 20 | — | $6,682 | $6,643.33 | $6,682.3 | $13,365 |
| AMI discharged alive w MCC | MS-DRG | 280 | 20 | — | $16,082 | $15,983 | $16,082 | $32,165 |
| AMI discharged alive w CC | MS-DRG | 281 | 20 | — | $9,482 | $9,425.29 | $9,482.28 | $18,965 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 20 | — | $7,593 | $7,548.95 | $7,593.78 | $15,188 |
| Heart failure & shock w MCC | MS-DRG | 291 | 20 | — | $12,996 | $12,917 | $12,996 | $25,992 |
| Heart failure & shock w CC | MS-DRG | 292 | 20 | — | $8,806 | $8,754.21 | $8,806.85 | $17,614 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 20 | — | $6,080 | $6,045.01 | $6,080.1 | $12,160 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 20 | — | $12,227 | $11,752 | $12,227 | $24,455 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 20 | — | $7,715 | $6,505.24 | $7,715.19 | $15,430 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 20 | — | $6,081 | $5,526.21 | $6,081.06 | $12,162 |
| GI hemorrhage w CC | MS-DRG | 378 | 20 | — | $10,075 | $10,015 | $10,076 | $20,152 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 20 | — | $6,700 | $6,661.52 | $6,700.6 | $13,401 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 20 | — | $8,138 | $7,902.11 | $8,138.17 | $16,276 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 20 | — | $15,731 | $15,634 | $15,732 | $31,463 |
| Kidney/UTI w MCC | MS-DRG | 689 | 20 | — | $11,806 | $11,734 | $11,806 | $23,613 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 20 | — | $8,426 | $7,704.82 | $8,426.26 | $16,853 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 20 | — | $19,342 | $19,223 | $19,343 | $38,686 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 20 | — | $10,486 | $9,219.33 | $10,486 | $20,973 |
| Hospital discharge, >30 min | CPT | 99239 | 7 | $571.9 | — | $76.6 | $79.28 | $571.9 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 24 | $809.88 | $8 | $8.04 | $8.46 | $16.92 |
| Electrolyte panel | CPT | 80051 | 24 | $284 | $7 | $6.66 | $7.01 | $14.02 |
| Comprehensive metabolic panel | CPT | 80053 | 24 | $1,150.88 | $10 | $10.03 | $10.56 | $21.12 |
| Lipid panel | CPT | 80061 | 24 | $827.75 | $13 | $12.72 | $13.39 | $26.78 |
| Renal function panel | CPT | 80069 | 24 | $534.88 | $8 | $8.25 | $8.68 | $17.36 |
| Hepatic function panel | CPT | 80076 | 24 | $548.63 | $8 | $7.32 | $8.17 | $16.34 |
| Urinalysis non-automated | CPT | 81002 | 24 | $81.03 | $3 | $2.47 | $3.48 | $6.96 |
| Urinalysis automated | CPT | 81003 | 24 | $126.73 | $2 | $2.14 | $2.25 | $4.5 |
| Glucose quantitative | CPT | 82947 | 24 | $158.21 | $3 | $3.73 | $3.93 | $7.86 |
| Hemoglobin A1c | CPT | 83036 | 24 | $215.88 | $9 | $9.22 | $9.71 | $19.42 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 24 | $434.5 | $16 | $15.96 | $16.8 | $33.6 |
| Complete blood count with automated differential | CPT | 85025 | 24 | $301.13 | $7 | $7.38 | $7.77 | $15.54 |
| Complete blood count without differential | CPT | 85027 | 24 | $158.35 | $6 | $6.15 | $6.47 | $12.94 |
| Urine culture bacterial | CPT | 87086 | 24 | $522.5 | $8 | $6.48 | $8.07 | $16.14 |
| Tissue exam by pathologist level IV | CPT | 88305 | 24 | $757.23 | $66 | $11.76 | $66.69 | $133.38 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 7 | $1,025 | — | $19.62 | $19.62 | $34.34 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 7 | $2,921 | — | $1,639.5 | $1,994.02 | $2,891.33 |
| Vaginal delivery only | CPT | 59409 | 24 | $15,632 | $4,143 | $780.72 | $4,143.08 | $8,286.16 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 24 | $10,179 | $1,160 | $321.48 | $1,160.81 | $2,321.62 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 24 | $10,819 | $1,160 | $335.91 | $1,160.81 | $2,321.62 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 25 | $5,910.28 | $1,190 | $78.5 | $1,190.22 | $2,380.44 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 25 | $5,112.7 | $1,190 | $103.61 | $1,190.22 | $2,380.44 |
| Colonoscopy diagnostic | CPT | 45378 | 25 | $9,928.6 | $1,190 | $423.48 | $1,190.22 | $2,380.44 |
| Colonoscopy with biopsy | CPT | 45380 | 25 | $9,591.67 | $1,531 | $473.68 | $1,531.54 | $3,063.08 |
| Colonoscopy with polyp removal | CPT | 45385 | 25 | $10,781 | $1,531 | $574.08 | $1,531.54 | $3,063.08 |
| surgery | ||||||||
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 20 | — | $44,914 | $44,630 | $44,915 | $89,829 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 20 | — | $23,724 | $23,575 | $23,724 | $47,448 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 20 | — | $16,841 | $16,737 | $16,842 | $33,683 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 20 | — | $16,925 | $16,821 | $16,925 | $33,851 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 20 | — | $13,786 | $13,702 | $13,786 | $27,573 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 20 | — | $33,454 | $33,243 | $33,455 | $70,166 |
| Laparoscopic appendectomy | CPT | 44970 | 24 | $19,308 | $7,737 | $391.98 | $7,737.45 | $15,475 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $97,034 | $97,034 | $97,034 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $53,517 | $53,517 | $53,517 |
| Major joint replacement w MCC | MS-DRG | 469 | 20 | — | $29,851 | $29,664 | $29,852 | $59,704 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 20 | — | $19,211 | $19,092 | $19,212 | $38,424 |
| Laparoscopic cholecystectomy | CPT | 47562 | 24 | $17,656 | $7,737 | $668.6 | $7,737.45 | $15,475 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 20 | — | $28,687 | $28,507 | $28,687 | $57,374 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 20 | — | $20,807 | $20,678 | $20,807 | $41,615 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 20 | — | $16,341 | $16,240 | $16,342 | $32,683 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 24 | $7,762.5 | $7,737 | $838.74 | $7,737.45 | $7,762.5 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 24 | $35,773 | $13,604 | $616.65 | $13,605 | $27,210 |
| Lap salpingo-oophorectomy | CPT | 58661 | 24 | $19,649 | $7,737 | $701.38 | $7,737.45 | $15,475 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 20 | — | $28,447 | $28,268 | $28,447 | $56,894 |
| OR procedure for obesity w CC | MS-DRG | 620 | 20 | — | $16,045 | $15,947 | $16,046 | $32,092 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 20 | — | $15,160 | $15,067 | $15,160 | $30,321 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 20 | — | $12,580 | $12,504 | $12,581 | $25,162 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 20 | — | $20,370 | $18,679 | $20,370 | $40,740 |
| PCI single major coronary artery | CPT | 92920 | 24 | $29,530 | $7,284 | $435.12 | $7,284.43 | $14,569 |
| PCI with drug-eluting stent | CPT | 92928 | 24 | $59,846 | $14,775 | $483.05 | $14,775 | $29,550 |
| PCI bypass graft | CPT | 92937 | 24 | $36,925 | $14,775 | $482.46 | $14,775 | $29,550 |
| Left heart catheterization | CPT | 93452 | 24 | $14,792 | $4,149 | $549.26 | $4,149.23 | $8,298.46 |
| Coronary angiography with cath | CPT | 93455 | 24 | $15,282 | $4,149 | $671.23 | $4,149.23 | $8,298.46 |
| Coronary angiography with bypass cath | CPT | 93458 | 24 | $18,229 | $4,149 | $693.51 | $4,149.23 | $8,298.46 |
Payer mix (top 26)
| Payer | Codes covered | Median rate |
|---|---|---|
| Health Net | 143 | $465.58 |
| Empire BCBS | 143 | $381.89 |
| vantage care | 143 | $224.48 |
| Molina | 143 | $305.38 |
| First Health | 142 | $570.55 |
| brand new day | 141 | $450.97 |
| epic health plan | 140 | $6,643.33 |
| worker compensation | 140 | $588.2 |
| central health plan | 140 | $446.5 |
| choice physicians network | 140 | $446.5 |
| elite health plan | 140 | $446.5 |
| emanate health | 140 | $610.76 |
| employer direct health care | 140 | $625.1 |
| imperial health plan of ca | 140 | $473.29 |
| Medicare | 140 | $446.5 |
| neighborhood | 140 | $455.43 |
| renal payor solution | 140 | $446.5 |
| TRICARE | 140 | $446.5 |
| alignment | 140 | $446.5 |
| traditional medi-cal | 100 | $132.16 |
| Blue Cross Blue Shield | 100 | $132.16 |
| Anthem BCBS | 99 | $335.2 |
| rios | 97 | $213.26 |
| citrus valley physicians group | 97 | $224.48 |
| national healthcare solutions, inc (nhsi) | 43 | $20,794 |
| catalina research institute | 5 | $600 |