|
LAPAROSCOPY ASPIRATION
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
6149322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.26 |
| Max. Negotiated Rate |
$909.15 |
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$813.45
|
| Rate for Payer: First Health Commercial |
$861.30
|
| Rate for Payer: First Health Workers Compensation |
$369.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$861.30
|
| Rate for Payer: GEHA Commercial |
$669.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$861.30
|
| Rate for Payer: Multiplan All |
$870.87
|
| Rate for Payer: OMNI Networks Commercial |
$669.90
|
| Rate for Payer: One Health Plan PPO/POS |
$861.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$909.15
|
| Rate for Payer: Three Rivers Provider Network All |
$717.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.01
|
| Rate for Payer: Zelis Auto |
$382.80
|
| Rate for Payer: Zelis Worker's Compensation |
$261.26
|
|
|
LAPAROSCOPY ASPIRATION
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
6149322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.26 |
| 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 |
$574.20
|
| 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 |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$813.45
|
| Rate for Payer: First Health Commercial |
$861.30
|
| Rate for Payer: First Health Workers Compensation |
$369.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$861.30
|
| Rate for Payer: GEHA Commercial |
$765.60
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$861.30
|
| 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 |
$870.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$669.90
|
| Rate for Payer: One Health Plan PPO/POS |
$861.30
|
| 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 |
$909.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$717.75
|
| 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 |
$890.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$382.80
|
| 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 |
$261.26
|
|
|
LAPAROSCOPY BIOPSY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
6149321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.70 |
| 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 |
$540.00
|
| 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 |
$5,539.96
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$765.00
|
| Rate for Payer: First Health Commercial |
$810.00
|
| Rate for Payer: First Health Workers Compensation |
$347.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.00
|
| Rate for Payer: GEHA Commercial |
$720.00
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.00
|
| 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 |
$819.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$630.00
|
| Rate for Payer: One Health Plan PPO/POS |
$810.00
|
| 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 |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$675.00
|
| 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 |
$837.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$360.00
|
| 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 |
$245.70
|
|
|
LAPAROSCOPY BIOPSY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
6149321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$765.00
|
| Rate for Payer: First Health Commercial |
$810.00
|
| Rate for Payer: First Health Workers Compensation |
$347.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.00
|
| Rate for Payer: GEHA Commercial |
$630.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.00
|
| Rate for Payer: Multiplan All |
$819.00
|
| Rate for Payer: OMNI Networks Commercial |
$630.00
|
| Rate for Payer: One Health Plan PPO/POS |
$810.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.00
|
| Rate for Payer: Three Rivers Provider Network All |
$675.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.00
|
| Rate for Payer: Zelis Auto |
$360.00
|
| Rate for Payer: Zelis Worker's Compensation |
$245.70
|
|
|
LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDU
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
1649329
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.16 |
| 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 |
$1,158.60
|
| 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 |
$1,158.60
|
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$1,641.35
|
| Rate for Payer: First Health Commercial |
$1,737.90
|
| Rate for Payer: First Health Workers Compensation |
$745.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.90
|
| Rate for Payer: GEHA Commercial |
$1,544.80
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.90
|
| 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 |
$1,757.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.90
|
| 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 |
$1,834.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,448.25
|
| 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 |
$1,795.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$772.40
|
| 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 |
$527.16
|
|
|
LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDU
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
1649329
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.16 |
| Max. Negotiated Rate |
$1,834.45 |
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$1,641.35
|
| Rate for Payer: First Health Commercial |
$1,737.90
|
| Rate for Payer: First Health Workers Compensation |
$745.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.90
|
| Rate for Payer: GEHA Commercial |
$1,351.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.90
|
| Rate for Payer: Multiplan All |
$1,757.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,834.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,448.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,795.83
|
| Rate for Payer: Zelis Auto |
$772.40
|
| Rate for Payer: Zelis Worker's Compensation |
$527.16
|
|
|
LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDU
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
6144180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.16 |
| Max. Negotiated Rate |
$1,834.45 |
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$1,641.35
|
| Rate for Payer: First Health Commercial |
$1,737.90
|
| Rate for Payer: First Health Workers Compensation |
$745.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.90
|
| Rate for Payer: GEHA Commercial |
$1,351.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.90
|
| Rate for Payer: Multiplan All |
$1,757.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,834.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,448.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,795.83
|
| Rate for Payer: Zelis Auto |
$772.40
|
| Rate for Payer: Zelis Worker's Compensation |
$527.16
|
|
|
LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDU
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
6144180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.16 |
| 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 |
$1,158.60
|
| 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 |
$1,158.60
|
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$1,641.35
|
| Rate for Payer: First Health Commercial |
$1,737.90
|
| Rate for Payer: First Health Workers Compensation |
$745.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.90
|
| Rate for Payer: GEHA Commercial |
$1,544.80
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.90
|
| 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 |
$1,757.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.90
|
| 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 |
$1,834.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,448.25
|
| 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 |
$1,795.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$772.40
|
| 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 |
$527.16
|
|
|
LAPAROSCOPY FUNDOPLASTY
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
CPT 43280
|
| Hospital Charge Code |
6143280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$622.44 |
| Max. Negotiated Rate |
$2,166.00 |
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$1,938.00
|
| Rate for Payer: First Health Commercial |
$2,052.00
|
| Rate for Payer: First Health Workers Compensation |
$880.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,052.00
|
| Rate for Payer: GEHA Commercial |
$1,596.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,052.00
|
| Rate for Payer: Multiplan All |
$2,074.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,596.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,052.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,166.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,710.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,120.40
|
| Rate for Payer: Zelis Auto |
$912.00
|
| Rate for Payer: Zelis Worker's Compensation |
$622.44
|
|
|
LAPAROSCOPY FUNDOPLASTY
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
CPT 43280
|
| Hospital Charge Code |
6143280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$622.44 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,368.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,843.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$1,938.00
|
| Rate for Payer: First Health Commercial |
$2,052.00
|
| Rate for Payer: First Health Workers Compensation |
$880.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,052.00
|
| Rate for Payer: GEHA Commercial |
$1,824.00
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,052.00
|
| 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 |
$5,962.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,074.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,596.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,052.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,884.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,962.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,166.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,710.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,962.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,120.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$912.00
|
| 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 |
$622.44
|
|
|
LAPAROSCOPY, GASTROSTOMY
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
CPT 43653
|
| Hospital Charge Code |
6143653
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.96 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: First Health Workers Compensation |
$461.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$835.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| Rate for Payer: Multiplan All |
$1,086.54
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,134.30
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,110.42
|
| Rate for Payer: Zelis Auto |
$477.60
|
| Rate for Payer: Zelis Worker's Compensation |
$325.96
|
|
|
LAPAROSCOPY, GASTROSTOMY
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
CPT 43653
|
| Hospital Charge Code |
6143653
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.96 |
| 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 |
$716.40
|
| 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 |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: First Health Workers Compensation |
$461.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$955.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| 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 |
$1,086.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| 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 |
$1,134.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| 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 |
$1,110.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$477.60
|
| 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 |
$325.96
|
|
|
LAPAROSCOPY LYSIS
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
6158660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.10 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$530.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$961.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Worker's Compensation |
$375.10
|
|
|
LAPAROSCOPY LYSIS
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
6158660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.10 |
| 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 |
$824.40
|
| 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 |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$530.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$1,099.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| 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 |
$1,250.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| 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 |
$1,305.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| 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 |
$1,277.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$549.60
|
| 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 |
$375.10
|
|
|
LAPAROSCOPY ORCHIECTOMY
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 54690
|
| Hospital Charge Code |
6154690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.97 |
| 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 |
$925.20
|
| 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 |
$925.20
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cigna Commercial |
$1,310.70
|
| Rate for Payer: First Health Commercial |
$1,387.80
|
| Rate for Payer: First Health Workers Compensation |
$595.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,387.80
|
| Rate for Payer: GEHA Commercial |
$1,233.60
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,387.80
|
| 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 |
$1,403.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,079.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,387.80
|
| 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 |
$1,464.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,156.50
|
| 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 |
$1,434.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$616.80
|
| 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 |
$420.97
|
|
|
LAPAROSCOPY ORCHIECTOMY
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 54690
|
| Hospital Charge Code |
6154690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.97 |
| Max. Negotiated Rate |
$1,464.90 |
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cigna Commercial |
$1,310.70
|
| Rate for Payer: First Health Commercial |
$1,387.80
|
| Rate for Payer: First Health Workers Compensation |
$595.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,387.80
|
| Rate for Payer: GEHA Commercial |
$1,079.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,387.80
|
| Rate for Payer: Multiplan All |
$1,403.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,079.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,387.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,464.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,156.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.06
|
| Rate for Payer: Zelis Auto |
$616.80
|
| Rate for Payer: Zelis Worker's Compensation |
$420.97
|
|
|
LAPAROSCOPY ORCHIOPEXY
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 54692
|
| Hospital Charge Code |
6154692
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.85 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,072.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,843.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$1,072.20
|
| Rate for Payer: Cash Price |
$1,072.20
|
| Rate for Payer: Cigna Commercial |
$1,518.95
|
| Rate for Payer: First Health Commercial |
$1,608.30
|
| Rate for Payer: First Health Workers Compensation |
$689.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,608.30
|
| Rate for Payer: GEHA Commercial |
$1,429.60
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,608.30
|
| 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 |
$5,962.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,626.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,608.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,884.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,962.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,697.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,340.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,962.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,661.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$714.80
|
| 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 |
$487.85
|
|
|
LAPAROSCOPY ORCHIOPEXY
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 54692
|
| Hospital Charge Code |
6154692
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.85 |
| Max. Negotiated Rate |
$1,697.65 |
| Rate for Payer: Cash Price |
$1,072.20
|
| Rate for Payer: Cigna Commercial |
$1,518.95
|
| Rate for Payer: First Health Commercial |
$1,608.30
|
| Rate for Payer: First Health Workers Compensation |
$689.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,608.30
|
| Rate for Payer: GEHA Commercial |
$1,250.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,608.30
|
| Rate for Payer: Multiplan All |
$1,626.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,608.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,697.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,661.91
|
| Rate for Payer: Zelis Auto |
$714.80
|
| Rate for Payer: Zelis Worker's Compensation |
$487.85
|
|
|
LAPAROSCOPY PYELOPLASTY
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
CPT 50544
|
| Hospital Charge Code |
6150544
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$702.98 |
| 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 |
$1,545.00
|
| 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 |
$1,545.00
|
| Rate for Payer: Cash Price |
$1,545.00
|
| Rate for Payer: Cigna Commercial |
$2,188.75
|
| Rate for Payer: First Health Commercial |
$2,317.50
|
| Rate for Payer: First Health Workers Compensation |
$994.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,317.50
|
| Rate for Payer: GEHA Commercial |
$2,060.00
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,317.50
|
| 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 |
$2,343.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,802.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,317.50
|
| 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 |
$2,446.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,931.25
|
| 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 |
$2,394.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,030.00
|
| 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 |
$702.98
|
|
|
LAPAROSCOPY PYELOPLASTY
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
CPT 50544
|
| Hospital Charge Code |
6150544
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$702.98 |
| Max. Negotiated Rate |
$2,446.25 |
| Rate for Payer: Cash Price |
$1,545.00
|
| Rate for Payer: Cigna Commercial |
$2,188.75
|
| Rate for Payer: First Health Commercial |
$2,317.50
|
| Rate for Payer: First Health Workers Compensation |
$994.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,317.50
|
| Rate for Payer: GEHA Commercial |
$1,802.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,317.50
|
| Rate for Payer: Multiplan All |
$2,343.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,802.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,317.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,446.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,931.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,394.75
|
| Rate for Payer: Zelis Auto |
$1,030.00
|
| Rate for Payer: Zelis Worker's Compensation |
$702.98
|
|
|
LAPAROSCOPY, REMOVE ADNEXA
|
Facility
|
OP
|
$1,936.65
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
6158661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$528.71 |
| 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 |
$1,161.99
|
| 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 |
$1,161.99
|
| Rate for Payer: Cash Price |
$1,161.99
|
| Rate for Payer: Cigna Commercial |
$1,646.15
|
| Rate for Payer: First Health Commercial |
$1,742.98
|
| Rate for Payer: First Health Workers Compensation |
$747.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,742.98
|
| Rate for Payer: GEHA Commercial |
$1,549.32
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,742.98
|
| 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 |
$1,762.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,355.65
|
| Rate for Payer: One Health Plan PPO/POS |
$1,742.98
|
| 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 |
$1,839.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,452.49
|
| 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 |
$1,801.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$774.66
|
| 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 |
$528.71
|
|
|
LAPAROSCOPY, REMOVE ADNEXA
|
Facility
|
IP
|
$1,936.65
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
6158661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$528.71 |
| Max. Negotiated Rate |
$1,839.82 |
| Rate for Payer: Cash Price |
$1,161.99
|
| Rate for Payer: Cigna Commercial |
$1,646.15
|
| Rate for Payer: First Health Commercial |
$1,742.98
|
| Rate for Payer: First Health Workers Compensation |
$747.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,742.98
|
| Rate for Payer: GEHA Commercial |
$1,355.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,742.98
|
| Rate for Payer: Multiplan All |
$1,762.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,355.65
|
| Rate for Payer: One Health Plan PPO/POS |
$1,742.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,839.82
|
| Rate for Payer: Three Rivers Provider Network All |
$1,452.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,801.08
|
| Rate for Payer: Zelis Auto |
$774.66
|
| Rate for Payer: Zelis Worker's Compensation |
$528.71
|
|
|
LAPAROSCOPY, SPLENECTOMY
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 38120
|
| Hospital Charge Code |
6138120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.15 |
| Max. Negotiated Rate |
$2,102.35 |
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$1,881.05
|
| Rate for Payer: First Health Commercial |
$1,991.70
|
| Rate for Payer: First Health Workers Compensation |
$854.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,991.70
|
| Rate for Payer: GEHA Commercial |
$1,549.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,991.70
|
| Rate for Payer: Multiplan All |
$2,013.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,549.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,991.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,102.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,659.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,058.09
|
| Rate for Payer: Zelis Auto |
$885.20
|
| Rate for Payer: Zelis Worker's Compensation |
$604.15
|
|
|
LAPAROSCOPY, SPLENECTOMY
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 38120
|
| Hospital Charge Code |
6138120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.15 |
| 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 |
$1,327.80
|
| 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 |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$1,881.05
|
| Rate for Payer: First Health Commercial |
$1,991.70
|
| Rate for Payer: First Health Workers Compensation |
$854.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,991.70
|
| Rate for Payer: GEHA Commercial |
$1,770.40
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,991.70
|
| 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 |
$2,013.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,549.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,991.70
|
| 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 |
$2,102.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,659.75
|
| 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 |
$2,058.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$885.20
|
| 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 |
$604.15
|
|
|
LAPAROSCOPY SUPRACERV HYSTERECTO 250GM/<
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
6158541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.15 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,327.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,843.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$1,881.05
|
| Rate for Payer: First Health Commercial |
$1,991.70
|
| Rate for Payer: First Health Workers Compensation |
$854.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,991.70
|
| Rate for Payer: GEHA Commercial |
$1,770.40
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,991.70
|
| 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 |
$5,962.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,013.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,549.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,991.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,884.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,962.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,102.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,659.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,962.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,058.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$885.20
|
| 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 |
$604.15
|
|
