|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0U944ZX
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FJ04ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0U943ZX
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FN64ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DJ00ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0WUF4KZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0D9V0ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0U924ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DNK4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0LJC14ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DJW4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FJD4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DBL4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UB14ZX
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 8ECXXCZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 8E098C2
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UL74ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0W0F4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0W9G00Z
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 00164Z9
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UB97ZX
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 59151
|
| Min. Negotiated Rate |
$619.71 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$619.71
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,209.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 49320
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$73.18
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,209.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring, radiofrequency
|
Facility
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58674
|
| Min. Negotiated Rate |
$1,090.14 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: Dignity Health Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12,861.31
|
| Rate for Payer: Humana Medicare |
$12,861.31
|
| Rate for Payer: IEHP Medi-Cal |
$1,090.14
|
| Rate for Payer: IEHP Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24,436.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,176.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,205.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,147.44
|
| Rate for Payer: TriValley Medical Group Senior |
$12,861.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
Laparoscopy, surgical, appendectomy
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 44970
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$7,258.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$85.38
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,209.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
