|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
IP
|
$2,995.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$599.00 |
| Max. Negotiated Rate |
$2,545.75 |
| Rate for Payer: Adventist Health Commercial |
$599.00
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,096.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,198.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,198.00
|
| Rate for Payer: Galaxy Health WC |
$2,545.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,797.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,901.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,767.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.80
|
| Rate for Payer: Multiplan Commercial |
$2,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,946.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,545.75
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTM MAD
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.85
|
| Rate for Payer: Blue Shield of California Commercial |
$203.02
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTM MAD
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTM MAD
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTM MAD
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.85
|
| Rate for Payer: Blue Shield of California Commercial |
$203.02
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTOM FT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTOM FT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTOM FT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTOM FT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM FIT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM FIT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM FIT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM FIT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM MADE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM MADE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.85
|
| Rate for Payer: Blue Shield of California Commercial |
$203.02
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM MADE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC LYMPH EDEMA GLOVE-CUSTOM MADE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.85
|
| Rate for Payer: Blue Shield of California Commercial |
$203.02
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
905358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.82
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| Rate for Payer: Blue Shield of California Commercial |
$97.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
915358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
905358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
915358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.82
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| Rate for Payer: Blue Shield of California Commercial |
$97.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.91
|
| Rate for Payer: Blue Shield of California Commercial |
$201.79
|
| Rate for Payer: Blue Shield of California Commercial |
$306.06
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.91
|
| Rate for Payer: Blue Shield of California Commercial |
$201.79
|
| Rate for Payer: Blue Shield of California Commercial |
$306.06
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
|
