|
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 |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| 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
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| 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 |
915380005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$144.00 |
| 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 |
$93.97
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| 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: 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: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: InnovAge PACE Commercial |
$80.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| 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 |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Riverside University Health System MISP |
$64.00
|
| 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 |
905380005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$144.00 |
| 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 |
$93.97
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| 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: 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: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: InnovAge PACE Commercial |
$80.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| 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 |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Riverside University Health System MISP |
$64.00
|
| 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 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 |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| 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
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| 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 |
$86.46 |
| Max. Negotiated Rate |
$237.60 |
| 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 |
$155.05
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| 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: 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: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: InnovAge PACE Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| 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 |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| 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
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$237.60 |
| 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 |
$155.05
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| 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: 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: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: InnovAge PACE Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| 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 |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| 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
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
905358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| 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 |
905358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$173.70 |
| 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 |
$113.35
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| 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: 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: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: InnovAge PACE Commercial |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.13
|
| 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 |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Riverside University Health System MISP |
$77.20
|
| 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
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
915358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$173.70 |
| 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 |
$113.35
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| 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: 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: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: InnovAge PACE Commercial |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.13
|
| 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 |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Riverside University Health System MISP |
$77.20
|
| 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 |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| 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 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 |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California Commercial |
$307.65
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| 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 |
915380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$358.20 |
| 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 |
$233.75
|
| Rate for Payer: Blue Shield of California Commercial |
$307.65
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| 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: 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: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: InnovAge PACE Commercial |
$199.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.18
|
| 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 |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Riverside University Health System MISP |
$159.20
|
| 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
|
OP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$358.20 |
| 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 |
$233.75
|
| Rate for Payer: Blue Shield of California Commercial |
$307.65
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| 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: 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: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: InnovAge PACE Commercial |
$199.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.18
|
| 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 |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Riverside University Health System MISP |
$159.20
|
| 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 |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California Commercial |
$307.65
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| 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 NODE NDLE BPSY, DP AX
|
Facility
|
IP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,238.20 |
| Max. Negotiated Rate |
$10,071.90 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.40
|
| Rate for Payer: Galaxy Health WC |
$9,512.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,464.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,927.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.20
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
| Rate for Payer: Networks By Design Commercial |
$7,274.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,512.35
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
OP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.22 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,865.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.80
|
| Rate for Payer: Cigna of CA HMO |
$7,162.24
|
| Rate for Payer: Cigna of CA PPO |
$8,281.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$9,512.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,464.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,274.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$9,512.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
OP
|
$11,285.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.45 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,257.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,865.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,206.75
|
| Rate for Payer: Cash Price |
$6,206.75
|
| Rate for Payer: Cash Price |
$6,206.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,028.00
|
| Rate for Payer: Cigna of CA HMO |
$7,222.40
|
| Rate for Payer: Cigna of CA PPO |
$8,350.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$9,592.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,771.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,156.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,527.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$8,463.75
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,335.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$9,592.25
|
| Rate for Payer: Prime Health Services Medicare |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,771.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
IP
|
$11,285.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$10,156.50 |
| Rate for Payer: Adventist Health Commercial |
$2,257.00
|
| Rate for Payer: Cash Price |
$6,206.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,028.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,514.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,514.00
|
| Rate for Payer: Galaxy Health WC |
$9,592.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,771.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,156.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,527.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,299.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,985.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.00
|
| Rate for Payer: Multiplan Commercial |
$8,463.75
|
| Rate for Payer: Networks By Design Commercial |
$7,335.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,592.25
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
OP
|
$11,710.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,342.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,865.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,440.50
|
| Rate for Payer: Cash Price |
$6,440.50
|
| Rate for Payer: Cash Price |
$6,440.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,368.00
|
| Rate for Payer: Cigna of CA HMO |
$7,494.40
|
| Rate for Payer: Cigna of CA PPO |
$8,665.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$9,953.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,539.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,810.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$8,782.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,611.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$9,953.50
|
| Rate for Payer: Prime Health Services Medicare |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,026.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
IP
|
$11,710.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,342.00 |
| Max. Negotiated Rate |
$10,539.00 |
| Rate for Payer: Adventist Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$6,440.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,684.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.00
|
| Rate for Payer: Galaxy Health WC |
$9,953.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,539.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,810.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,461.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,248.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.00
|
| Rate for Payer: Multiplan Commercial |
$8,782.50
|
| Rate for Payer: Networks By Design Commercial |
$7,611.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,953.50
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$4,523.40 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,010.40
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,523.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,352.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,111.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.20
|
| Rate for Payer: Multiplan Commercial |
$3,769.50
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
OP
|
$5,026.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.67 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,020.80
|
| Rate for Payer: Cigna of CA HMO |
$3,216.64
|
| Rate for Payer: Cigna of CA PPO |
$3,719.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,523.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$121.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,352.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,769.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,015.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$457.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$320.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$319.89
|
| Rate for Payer: Blue Shield of California EPN |
$209.22
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Central Health Plan Commercial |
$421.60
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$474.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: InnovAge PACE Commercial |
$685.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$457.06
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Prime Health Services Medicare |
$484.48
|
| Rate for Payer: Riverside University Health System MISP |
$502.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
