Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
XR HIP W WO PELV 2VWS BIL
Sacramento, CA
Negotiated rates from the hospital’s own file: 10 payers, 31 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare medicaid|< 21 fee schedule · outpatient | $35 | $35 | — | — | — | $35 – $35 |
| 2 | UnitedHealthcare medicaid|> 21 fee schedule · outpatient | $35 | $35 | — | — | — | $35 – $35 |
| 3 | Molina medicaid|all plans fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 4 | Anthem medicaid|all plans fee schedule · outpatient | $100 | $100 | — | — | — | $100 – $100 |
| 5 | Aetna commercial|all other plans fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 6 | Aetna commercial|hmo fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 7 | Aetna commercial|ppo fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 8 | Anthem medicare|all other plans fee schedule · outpatient | $132 | $132 | — | — | — | $132 – $132 |
| 9 | Aetna medicare|all plans fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 10 | Blue Cross Blue Shield medicare|all plans case rate · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 11 | Humana commercial|all plans fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 12 | Humana medicare|all plans fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 13 | Kaiser medicare|all plans fee schedule · outpatient | $140 | $140 | — | — | 1–10 | $140 – $140 |
| 14 | UnitedHealthcare medicare|all plans fee schedule · outpatient | $143 | $143 | — | — | — | $143 – $143 |
| 15 | Anthem medicare|imperial fee schedule · outpatient | $144 | $144 | — | — | — | $144 – $144 |
| 16 | UnitedHealthcare commercial|all other plans fee schedule · outpatient | $245 | $245 | — | — | 1–10 | $245 – $245 |
| 17 | UnitedHealthcare commercial|hmo fee schedule · outpatient | $245 | $245 | — | — | — | $245 – $245 |
| 18 | UnitedHealthcare commercial|non-options ppo fee schedule · outpatient | $245 | $245 | — | — | — | $245 – $245 |
| 19 | UnitedHealthcare commercial|options ppo fee schedule · outpatient | $245 | $245 | — | — | — | $245 – $245 |
| 20 | Cigna commercial|localplus fee schedule · outpatient | $440 | $440 | — | — | — | $440 – $440 |
| 21 | Kaiser medicaid|all plans fee schedule · outpatient | $480 | $480 | — | — | — | $480 – $480 |
| 22 | Cigna commercial|all other plans fee schedule · outpatient | $587 | $587 | — | — | — | $587 – $587 |
| 23 | Anthem commercial|connection epo fee schedule · outpatient | $589 | $589 | — | — | — | $589 – $589 |
| 24 | Anthem commercial|all other plans fee schedule · outpatient | $736 | $736 | — | — | — | $736 – $736 |
| 25 | Anthem commercial|brms fee schedule · outpatient | $878 | $878 | — | — | — | $878 – $878 |