|
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: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$619.71
|
| Rate for Payer: Inland Empire Health Plan (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: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.18
|
| Rate for Payer: Inland Empire Health Plan (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: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,090.14
|
| Rate for Payer: Inland Empire Health Plan (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: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.38
|
| Rate for Payer: Inland Empire Health Plan (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; cholecystectomy
|
Facility
|
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 47562
|
| Min. Negotiated Rate |
$727.15 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$7,258.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$727.15
|
| Rate for Payer: Inland Empire Health Plan (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; cholecystectomy with cholangiography
|
Facility
|
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 47563
|
| Min. Negotiated Rate |
$167.26 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$7,258.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.26
|
| Rate for Payer: Inland Empire Health Plan (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, colpopexy (suspension of vaginal apex)
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 57425
|
| Min. Negotiated Rate |
$159.29 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$159.29
|
| Rate for Payer: Inland Empire Health Plan (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, enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Facility
|
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 44180
|
| Min. Negotiated Rate |
$211.99 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.99
|
| Rate for Payer: Inland Empire Health Plan (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, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 43280
|
| Min. Negotiated Rate |
$249.74 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$249.74
|
| Rate for Payer: Inland Empire Health Plan (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, gastric restrictive procedure; removal of adjustable gastric restrictive device component only
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 43772
|
| Min. Negotiated Rate |
$1,100.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,100.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,263.53
|
| Rate for Payer: TriValley Medical Group Senior |
$4,785.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 43644
|
| Min. Negotiated Rate |
$295.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,449.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$295.89
|
|
|
Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas
|
Facility
|
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 58545
|
| Min. Negotiated Rate |
$1,246.03 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,246.03
|
| Rate for Payer: Inland Empire Health Plan (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, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58546
|
| Min. Negotiated Rate |
$592.85 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$592.85
|
| Rate for Payer: Inland Empire Health Plan (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; nephrectomy, including partial ureterectomy
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 50546
|
| Min. Negotiated Rate |
$1,155.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,155.18
|
|
|
Laparoscopy, surgical; partial nephrectomy
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 50543
|
| Min. Negotiated Rate |
$200.07 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.07
|
| Rate for Payer: Inland Empire Health Plan (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 prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 55866
|
| Min. Negotiated Rate |
$1,487.09 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,487.09
|
| Rate for Payer: Inland Empire Health Plan (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; pyeloplasty
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 50544
|
| Min. Negotiated Rate |
$1,245.78 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,245.78
|
| Rate for Payer: Inland Empire Health Plan (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; repair initial inguinal hernia
|
Facility
|
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 49650
|
| Min. Negotiated Rate |
$412.95 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$412.95
|
| Rate for Payer: Inland Empire Health Plan (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, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 43282
|
| Min. Negotiated Rate |
$446.05 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.05
|
| Rate for Payer: Inland Empire Health Plan (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; repair recurrent inguinal hernia
|
Facility
|
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 49651
|
| Min. Negotiated Rate |
$100.48 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.48
|
| Rate for Payer: Inland Empire Health Plan (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, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 49653
|
| Min. Negotiated Rate |
$7,436.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
|
|
Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic)
|
Facility
|
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 51992
|
| Min. Negotiated Rate |
$809.03 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$809.03
|
| Rate for Payer: Inland Empire Health Plan (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, supracervical hysterectomy, for uterus 250 g or less;
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58541
|
| Min. Negotiated Rate |
$1,109.00 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,109.00
|
| Rate for Payer: Inland Empire Health Plan (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, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
|
Facility
|
OP
|
$24,436.49
|
|
|
Service Code
|
CPT 58542
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,090.03
|
| Rate for Payer: Inland Empire Health Plan (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 adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal
|
Facility
|
OP
|
$9,792.00
|
|
|
Service Code
|
CPT 60650
|
| Min. Negotiated Rate |
$274.72 |
| Max. Negotiated Rate |
$9,792.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.72
|
|
