|
LamoTRIgine TAB 25MG
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 51079049801
|
| Hospital Charge Code |
3300491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
LamoTRIgine TAB 25MG
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 51079049801
|
| Hospital Charge Code |
3300491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$25.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Humana ChoiceCare |
$8.32
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.20
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
LANSOPRAZOLE 15MG DELAYED RELEASE CAP
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
NDC 45963046003
|
| Hospital Charge Code |
3300492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$27.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Humana ChoiceCare |
$8.84
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
LANSOPRAZOLE 15MG DELAYED RELEASE CAP
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
NDC 45963046003
|
| Hospital Charge Code |
3300492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$23.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
LANSOPRAZOLE 30MG DELAYED RELEASE CAP
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
NDC 00300304611
|
| Hospital Charge Code |
3300493
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
LANSOPRAZOLE 30MG DELAYED RELEASE CAP
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
NDC 00300304611
|
| Hospital Charge Code |
3300493
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Humana ChoiceCare |
$10.66
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.60
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
LANSOPRAZOLE 30MG ODT
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00300154430
|
| Hospital Charge Code |
3300494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$29.75
|
| Rate for Payer: First Health Commercial |
$31.50
|
| Rate for Payer: First Health Workers Compensation |
$13.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$31.50
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$31.50
|
| Rate for Payer: Humana ChoiceCare |
$9.10
|
| Rate for Payer: Multiplan All |
$31.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.00
|
| Rate for Payer: OMNI Networks Commercial |
$24.50
|
| Rate for Payer: One Health Plan PPO/POS |
$31.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$33.25
|
| Rate for Payer: Three Rivers Provider Network All |
$26.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$32.55
|
| Rate for Payer: Zelis Auto |
$14.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.50
|
| Rate for Payer: Zelis Worker's Compensation |
$9.55
|
|
|
LANSOPRAZOLE 30MG ODT
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00300154430
|
| Hospital Charge Code |
3300494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$29.75
|
| Rate for Payer: First Health Commercial |
$31.50
|
| Rate for Payer: First Health Workers Compensation |
$13.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$31.50
|
| Rate for Payer: GEHA Commercial |
$24.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$31.50
|
| Rate for Payer: Multiplan All |
$31.85
|
| Rate for Payer: OMNI Networks Commercial |
$24.50
|
| Rate for Payer: One Health Plan PPO/POS |
$31.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$33.25
|
| Rate for Payer: Three Rivers Provider Network All |
$26.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$32.55
|
| Rate for Payer: Zelis Auto |
$14.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.55
|
|
|
LAPARO ABLATE RENAL CYST
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 50541
|
| Hospital Charge Code |
6150541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,048.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,615.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: First Health Workers Compensation |
$733.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,710.00
|
| Rate for Payer: GEHA Commercial |
$1,520.00
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,710.00
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,110.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$1,729.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,330.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,710.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,591.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,110.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,805.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,110.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,767.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$760.00
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$518.70
|
|
|
LAPARO ABLATE RENAL CYST
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
CPT 50541
|
| Hospital Charge Code |
6150541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$1,805.00 |
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,615.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: First Health Workers Compensation |
$733.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,710.00
|
| Rate for Payer: GEHA Commercial |
$1,330.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,710.00
|
| Rate for Payer: Multiplan All |
$1,729.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,330.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,710.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,805.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,425.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,767.00
|
| Rate for Payer: Zelis Auto |
$760.00
|
| Rate for Payer: Zelis Worker's Compensation |
$518.70
|
|
|
LAPARO ABLATE RENAL MASS
|
Facility
|
IP
|
$2,410.00
|
|
|
Service Code
|
CPT 50542
|
| Hospital Charge Code |
6150542
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$657.93 |
| Max. Negotiated Rate |
$2,289.50 |
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$2,048.50
|
| Rate for Payer: First Health Commercial |
$2,169.00
|
| Rate for Payer: First Health Workers Compensation |
$930.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,169.00
|
| Rate for Payer: GEHA Commercial |
$1,687.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,169.00
|
| Rate for Payer: Multiplan All |
$2,193.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,687.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,169.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,289.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,807.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,241.30
|
| Rate for Payer: Zelis Auto |
$964.00
|
| Rate for Payer: Zelis Worker's Compensation |
$657.93
|
|
|
LAPARO ABLATE RENAL MASS
|
Facility
|
OP
|
$2,410.00
|
|
|
Service Code
|
CPT 50542
|
| Hospital Charge Code |
6150542
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$657.93 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,114.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,446.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,114.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,804.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$2,048.50
|
| Rate for Payer: First Health Commercial |
$2,169.00
|
| Rate for Payer: First Health Workers Compensation |
$930.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,169.00
|
| Rate for Payer: GEHA Commercial |
$1,928.00
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,169.00
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,984.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,193.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,687.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,169.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,373.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,984.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,289.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,807.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,984.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,241.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$964.00
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$657.93
|
|
|
LAPARO CHOLECYSTECTOMY/EXPLR
|
Facility
|
OP
|
$2,339.00
|
|
|
Service Code
|
CPT 47564
|
| Hospital Charge Code |
6147564
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.55 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,403.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cigna Commercial |
$1,988.15
|
| Rate for Payer: First Health Commercial |
$2,105.10
|
| Rate for Payer: First Health Workers Compensation |
$903.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,105.10
|
| Rate for Payer: GEHA Commercial |
$1,871.20
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,105.10
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,128.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,637.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,105.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,222.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,754.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,175.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$935.60
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$638.55
|
|
|
LAPARO CHOLECYSTECTOMY/EXPLR
|
Facility
|
IP
|
$2,339.00
|
|
|
Service Code
|
CPT 47564
|
| Hospital Charge Code |
6147564
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.55 |
| Max. Negotiated Rate |
$2,222.05 |
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cigna Commercial |
$1,988.15
|
| Rate for Payer: First Health Commercial |
$2,105.10
|
| Rate for Payer: First Health Workers Compensation |
$903.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,105.10
|
| Rate for Payer: GEHA Commercial |
$1,637.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,105.10
|
| Rate for Payer: Multiplan All |
$2,128.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,637.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,105.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,222.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,754.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,175.27
|
| Rate for Payer: Zelis Auto |
$935.60
|
| Rate for Payer: Zelis Worker's Compensation |
$638.55
|
|
|
LAPARO CHOLECYSTECTOMY/GRAPH
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
6147563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,424.05 |
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cigna Commercial |
$1,274.15
|
| Rate for Payer: First Health Commercial |
$1,349.10
|
| Rate for Payer: First Health Workers Compensation |
$578.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,349.10
|
| Rate for Payer: GEHA Commercial |
$1,049.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,349.10
|
| Rate for Payer: Multiplan All |
$1,364.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,049.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,349.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,424.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,124.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,394.07
|
| Rate for Payer: Zelis Auto |
$599.60
|
| Rate for Payer: Zelis Worker's Compensation |
$409.23
|
|
|
LAPARO CHOLECYSTECTOMY/GRAPH
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
6147563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$899.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cigna Commercial |
$1,274.15
|
| Rate for Payer: First Health Commercial |
$1,349.10
|
| Rate for Payer: First Health Workers Compensation |
$578.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,349.10
|
| Rate for Payer: GEHA Commercial |
$1,199.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,349.10
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,364.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,049.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,349.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,424.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,124.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,394.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$599.60
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$409.23
|
|
|
LAPARO CHOLECYSTOENTEROSTOMY
|
Facility
|
OP
|
$1,609.00
|
|
|
Service Code
|
CPT 47570
|
| Hospital Charge Code |
6147570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.25 |
| Max. Negotiated Rate |
$1,528.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$965.40
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,367.65
|
| Rate for Payer: First Health Commercial |
$1,448.10
|
| Rate for Payer: First Health Workers Compensation |
$621.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,448.10
|
| Rate for Payer: GEHA Commercial |
$1,287.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,448.10
|
| Rate for Payer: Humana ChoiceCare |
$418.34
|
| Rate for Payer: Multiplan All |
$1,464.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$965.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,126.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,448.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,528.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,206.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,415.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$402.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,496.37
|
| Rate for Payer: Zelis Auto |
$643.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$804.50
|
| Rate for Payer: Zelis Worker's Compensation |
$439.26
|
|
|
LAPARO CHOLECYSTOENTEROSTOMY
|
Facility
|
IP
|
$1,609.00
|
|
|
Service Code
|
CPT 47570
|
| Hospital Charge Code |
6147570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$439.26 |
| Max. Negotiated Rate |
$1,528.55 |
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,367.65
|
| Rate for Payer: First Health Commercial |
$1,448.10
|
| Rate for Payer: First Health Workers Compensation |
$621.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,448.10
|
| Rate for Payer: GEHA Commercial |
$1,126.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,448.10
|
| Rate for Payer: Multiplan All |
$1,464.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,126.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,448.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,528.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,206.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,496.37
|
| Rate for Payer: Zelis Auto |
$643.60
|
| Rate for Payer: Zelis Worker's Compensation |
$439.26
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 49323
|
| Hospital Charge Code |
6149323
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$362.54 |
| Max. Negotiated Rate |
$1,261.60 |
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cigna Commercial |
$1,128.80
|
| Rate for Payer: First Health Commercial |
$1,195.20
|
| Rate for Payer: First Health Workers Compensation |
$512.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,195.20
|
| Rate for Payer: GEHA Commercial |
$929.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,195.20
|
| Rate for Payer: Multiplan All |
$1,208.48
|
| Rate for Payer: OMNI Networks Commercial |
$929.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,195.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,261.60
|
| Rate for Payer: Three Rivers Provider Network All |
$996.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,235.04
|
| Rate for Payer: Zelis Auto |
$531.20
|
| Rate for Payer: Zelis Worker's Compensation |
$362.54
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 49323
|
| Hospital Charge Code |
6149323
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$362.54 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$796.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,048.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cigna Commercial |
$1,128.80
|
| Rate for Payer: First Health Commercial |
$1,195.20
|
| Rate for Payer: First Health Workers Compensation |
$512.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,195.20
|
| Rate for Payer: GEHA Commercial |
$1,062.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,195.20
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,110.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,208.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$929.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,195.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,591.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,110.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,261.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$996.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,110.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,235.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$531.20
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$362.54
|
|
|
LAPARO LIGATE SPERMATIC VEIN
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 55550
|
| Hospital Charge Code |
6155550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.51 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: First Health Workers Compensation |
$340.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$240.51
|
|
|
LAPARO LIGATE SPERMATIC VEIN
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 55550
|
| Hospital Charge Code |
6155550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.51 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: First Health Workers Compensation |
$340.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Worker's Compensation |
$240.51
|
|
|
LAPARO NEW URETER/BLADDER
|
Facility
|
OP
|
$2,876.00
|
|
|
Service Code
|
CPT 50947
|
| Hospital Charge Code |
6150947
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$785.15 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,725.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cigna Commercial |
$2,444.60
|
| Rate for Payer: First Health Commercial |
$2,588.40
|
| Rate for Payer: First Health Workers Compensation |
$1,110.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,588.40
|
| Rate for Payer: GEHA Commercial |
$2,300.80
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,588.40
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,617.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,013.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,588.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,732.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,157.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,674.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,150.40
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$785.15
|
|
|
LAPARO NEW URETER/BLADDER
|
Facility
|
OP
|
$2,641.00
|
|
|
Service Code
|
CPT 50948
|
| Hospital Charge Code |
6150948
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$720.99 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,584.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,584.60
|
| Rate for Payer: Cash Price |
$1,584.60
|
| Rate for Payer: Cigna Commercial |
$2,244.85
|
| Rate for Payer: First Health Commercial |
$2,376.90
|
| Rate for Payer: First Health Workers Compensation |
$1,019.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,376.90
|
| Rate for Payer: GEHA Commercial |
$2,112.80
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,376.90
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,403.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,848.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,376.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,508.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,980.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,456.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,056.40
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$720.99
|
|
|
LAPARO NEW URETER/BLADDER
|
Facility
|
IP
|
$2,876.00
|
|
|
Service Code
|
CPT 50947
|
| Hospital Charge Code |
6150947
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$785.15 |
| Max. Negotiated Rate |
$2,732.20 |
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cigna Commercial |
$2,444.60
|
| Rate for Payer: First Health Commercial |
$2,588.40
|
| Rate for Payer: First Health Workers Compensation |
$1,110.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,588.40
|
| Rate for Payer: GEHA Commercial |
$2,013.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,588.40
|
| Rate for Payer: Multiplan All |
$2,617.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,013.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,588.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,732.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,157.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,674.68
|
| Rate for Payer: Zelis Auto |
$1,150.40
|
| Rate for Payer: Zelis Worker's Compensation |
$785.15
|
|
