|
Laparoscopy, surgical; with biopsy (single or multiple)
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 49321
|
| Min. Negotiated Rate |
$389.13 |
| 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 |
$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 |
$389.13
|
| 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; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 58662
|
| Min. Negotiated Rate |
$476.83 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| 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 |
$476.83
|
| 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; with insertion of tunneled intraperitoneal catheter
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 49324
|
| Min. Negotiated Rate |
$486.02 |
| 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 |
$3,237.00
|
| 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 |
$486.02
|
| 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; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 58660
|
| Min. Negotiated Rate |
$437.91 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| 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 |
$9,792.00
|
| 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 |
$437.91
|
| 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; with omentopexy (omental tacking procedure) (List separately in addition to code for primary procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 49326
|
| Min. Negotiated Rate |
$237.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$237.42
|
|
|
Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed
|
Facility
OP
|
$10,742.00
|
|
|
Service Code
|
CPT 58548
|
| Min. Negotiated Rate |
$2,600.83 |
| Max. Negotiated Rate |
$10,742.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,809.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$2,600.83
|
|
|
Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 58661
|
| Min. Negotiated Rate |
$152.55 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| 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 |
$8,576.00
|
| 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 |
$152.55
|
| 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; with retroperitoneal lymph node sampling (biopsy), single or multiple
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 38570
|
| Min. Negotiated Rate |
$597.64 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 |
$597.64
|
| 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; with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 49325
|
| Min. Negotiated Rate |
$522.43 |
| 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 |
$3,237.00
|
| 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 |
$522.43
|
| 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, with total hysterectomy, for uterus 250 g or less;
|
Facility
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58570
|
| Min. Negotiated Rate |
$1,064.73 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 |
$10,742.00
|
| 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 |
$1,064.73
|
| 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, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
|
Facility
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58571
|
| Min. Negotiated Rate |
$233.19 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 |
$10,742.00
|
| 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 |
$233.19
|
| 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, with total hysterectomy, for uterus greater than 250 g;
|
Facility
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58572
|
| Min. Negotiated Rate |
$1,320.85 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 |
$10,742.00
|
| 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 |
$1,320.85
|
| 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, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
|
Facility
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58573
|
| Min. Negotiated Rate |
$298.79 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 |
$10,742.00
|
| 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 |
$298.79
|
| 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, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
|
Facility
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58552
|
| Min. Negotiated Rate |
$1,358.46 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| 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 |
$10,742.00
|
| 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 |
$1,358.46
|
| 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, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
|
Facility
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58554
|
| Min. Negotiated Rate |
$1,798.07 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| 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 |
$10,742.00
|
| 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 |
$1,798.07
|
| 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
|
|
|
Lap Band Surgery
|
Facility
IP
|
$13,869.00
|
|
|
Service Code
|
ICD 0DV64CZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$13,869.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$13,869.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Lap Band Surgery
|
Facility
IP
|
$13,869.00
|
|
|
Service Code
|
ICD 0DW643Z
|
| Min. Negotiated Rate |
$13,869.00 |
| Max. Negotiated Rate |
$13,869.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$13,869.00
|
|
|
Lap Band Surgery
|
Facility
IP
|
$13,869.00
|
|
|
Service Code
|
ICD 0DW64CZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$13,869.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$13,869.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]
|
Facility
OP
|
$247.05
|
|
|
Service Code
|
CPT J1931
|
| Hospital Charge Code |
1753490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.82 |
| Max. Negotiated Rate |
$185.29 |
| Rate for Payer: Adventist Health Commercial |
$49.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.79
|
| Rate for Payer: Blue Shield of California Commercial |
$34.82
|
| Rate for Payer: Blue Shield of California EPN |
$34.82
|
| Rate for Payer: Cash Price |
$111.17
|
| Rate for Payer: Cash Price |
$111.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.19
|
| Rate for Payer: Dignity Health Senior |
$41.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.38
|
| Rate for Payer: Heritage Provider Network Senior |
$114.38
|
| Rate for Payer: Humana Medicare |
$37.44
|
| Rate for Payer: IEHP Medi-Cal |
$65.36
|
| Rate for Payer: IEHP Medicare Advantage |
$37.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.18
|
| Rate for Payer: Multiplan Commercial |
$185.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.19
|
| Rate for Payer: TriValley Medical Group Senior |
$37.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$82.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.19
|
| Rate for Payer: Vantage Medical Group Senior |
$37.44
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]
|
Facility
IP
|
$247.05
|
|
|
Service Code
|
CPT J1931
|
| Hospital Charge Code |
1753490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$185.29 |
| Rate for Payer: Adventist Health Commercial |
$49.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.72
|
| Rate for Payer: Cash Price |
$111.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.25
|
| Rate for Payer: Heritage Provider Network Senior |
$167.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.76
|
| Rate for Payer: Multiplan Commercial |
$185.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$82.54
|
|
|
Laryngoplasty, medialization, unilateral
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 31591
|
| Min. Negotiated Rate |
$1,429.32 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$1,429.32
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Laryngoscopy, direct, operative, with biopsy;
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31535
|
| Min. Negotiated Rate |
$348.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$348.47
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$4,678.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31536
|
| Min. Negotiated Rate |
$418.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$418.17
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$4,678.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis;
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31540
|
| Min. Negotiated Rate |
$348.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$348.47
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$4,678.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31541
|
| Min. Negotiated Rate |
$418.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$418.17
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$4,678.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
