|
LAPAROSCOPY SUPRACERV HYSTERECTO 250GM/<
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
23500065
|
|
Hospital Revenue Code
|
519
|
| 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 SUPRACERV HYSTERECTO 250GM/<
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
6158541
|
|
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 SUPRACERV HYSTERECTO 250GM/<
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
23500065
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
LAPAROSCOPY SURG COLPOPEXY
|
Facility
|
OP
|
$1,974.00
|
|
|
Service Code
|
CPT 57425
|
| Hospital Charge Code |
6157425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$538.90 |
| 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 |
$1,184.40
|
| 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 |
$1,184.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cigna Commercial |
$1,677.90
|
| Rate for Payer: First Health Commercial |
$1,776.60
|
| Rate for Payer: First Health Workers Compensation |
$762.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,776.60
|
| Rate for Payer: GEHA Commercial |
$1,579.20
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,776.60
|
| 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 |
$1,796.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,381.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,776.60
|
| 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 |
$1,875.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,480.50
|
| 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 |
$1,835.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$789.60
|
| 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 |
$538.90
|
|
|
LAPAROSCOPY SURG COLPOPEXY
|
Facility
|
IP
|
$1,974.00
|
|
|
Service Code
|
CPT 57425
|
| Hospital Charge Code |
6157425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$538.90 |
| Max. Negotiated Rate |
$1,875.30 |
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cigna Commercial |
$1,677.90
|
| Rate for Payer: First Health Commercial |
$1,776.60
|
| Rate for Payer: First Health Workers Compensation |
$762.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,776.60
|
| Rate for Payer: GEHA Commercial |
$1,381.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,776.60
|
| Rate for Payer: Multiplan All |
$1,796.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,381.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,776.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,875.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,480.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,835.82
|
| Rate for Payer: Zelis Auto |
$789.60
|
| Rate for Payer: Zelis Worker's Compensation |
$538.90
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 47563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)
|
Facility
|
OP
|
$19,771.74
|
|
|
Service Code
|
CPT 57425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,048.07 |
| 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 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: First Health Workers Compensation |
$12,723.11
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| 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: New Mexico Health Connections Medicare |
$16,805.98
|
| 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 Worker's Compensation |
$19,771.74
|
| 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: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| 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 |
$8,996.14
|
|
|
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 44180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
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
|
$11,079.92
|
|
|
Service Code
|
CPT 58545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,048.07 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 49650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 58662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING)
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 58671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 58661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| 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: New Mexico Health Connections Medicare |
$9,417.93
|
| 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 Worker's Compensation |
$11,079.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| 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 |
$5,041.36
|
|
|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$19,771.74
|
|
|
Service Code
|
CPT 58552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$12,723.11
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| 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: New Mexico Health Connections Medicare |
$16,805.98
|
| 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 |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| 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: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| 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 |
$8,996.14
|
|
|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;
|
Facility
|
OP
|
$19,771.74
|
|
|
Service Code
|
CPT 58553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| 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 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: First Health Workers Compensation |
$12,723.11
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| 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: New Mexico Health Connections Medicare |
$16,805.98
|
| 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 |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| 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: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| 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 |
$8,996.14
|
|
|
LAPAROSCOPY URETEROLITHOTOMY
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 50945
|
| Hospital Charge Code |
6150945
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$548.46 |
| Max. Negotiated Rate |
$1,908.55 |
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cigna Commercial |
$1,707.65
|
| Rate for Payer: First Health Commercial |
$1,808.10
|
| Rate for Payer: First Health Workers Compensation |
$775.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,808.10
|
| Rate for Payer: GEHA Commercial |
$1,406.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,808.10
|
| Rate for Payer: Multiplan All |
$1,828.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,406.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,808.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,908.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,506.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,868.37
|
| Rate for Payer: Zelis Auto |
$803.60
|
| Rate for Payer: Zelis Worker's Compensation |
$548.46
|
|
|
LAPAROSCOPY URETEROLITHOTOMY
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 50945
|
| Hospital Charge Code |
6150945
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$548.46 |
| 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 |
$1,205.40
|
| 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 |
$1,205.40
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cigna Commercial |
$1,707.65
|
| Rate for Payer: First Health Commercial |
$1,808.10
|
| Rate for Payer: First Health Workers Compensation |
$775.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,808.10
|
| Rate for Payer: GEHA Commercial |
$1,607.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,808.10
|
| 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 |
$1,828.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,406.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,808.10
|
| 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 |
$1,908.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,506.75
|
| 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 |
$1,868.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$803.60
|
| 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 |
$548.46
|
|
|
LAPAROSCOPY, VAGUS NERVE
|
Facility
|
OP
|
$1,363.00
|
|
|
Service Code
|
CPT 43651
|
| Hospital Charge Code |
6143651
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.10 |
| 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 |
$817.80
|
| 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 |
$5,539.96
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$1,090.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| 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 |
$1,240.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| 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 |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| 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 |
$1,267.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$545.20
|
| 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 |
$372.10
|
|
|
LAPAROSCOPY, VAGUS NERVE
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 43652
|
| Hospital Charge Code |
6143652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.71 |
| Max. Negotiated Rate |
$1,526.65 |
| Rate for Payer: Cash Price |
$964.20
|
| Rate for Payer: Cigna Commercial |
$1,365.95
|
| Rate for Payer: First Health Commercial |
$1,446.30
|
| Rate for Payer: First Health Workers Compensation |
$620.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,446.30
|
| Rate for Payer: GEHA Commercial |
$1,124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,446.30
|
| Rate for Payer: Multiplan All |
$1,462.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,446.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,526.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,205.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,494.51
|
| Rate for Payer: Zelis Auto |
$642.80
|
| Rate for Payer: Zelis Worker's Compensation |
$438.71
|
|
|
LAPAROSCOPY, VAGUS NERVE
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 43652
|
| Hospital Charge Code |
6143652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.71 |
| 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 |
$964.20
|
| 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 |
$964.20
|
| Rate for Payer: Cash Price |
$964.20
|
| Rate for Payer: Cigna Commercial |
$1,365.95
|
| Rate for Payer: First Health Commercial |
$1,446.30
|
| Rate for Payer: First Health Workers Compensation |
$620.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,446.30
|
| Rate for Payer: GEHA Commercial |
$1,285.60
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,446.30
|
| 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 |
$1,462.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,446.30
|
| 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 |
$1,526.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,205.25
|
| 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 |
$1,494.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$642.80
|
| 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 |
$438.71
|
|
|
LAPAROSCOPY, VAGUS NERVE
|
Facility
|
IP
|
$1,363.00
|
|
|
Service Code
|
CPT 43651
|
| Hospital Charge Code |
6143651
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.10 |
| Max. Negotiated Rate |
$1,294.85 |
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$954.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| Rate for Payer: Multiplan All |
$1,240.33
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,267.59
|
| Rate for Payer: Zelis Auto |
$545.20
|
| Rate for Payer: Zelis Worker's Compensation |
$372.10
|
|
|
LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVID
|
Facility
|
OP
|
$1,101.03
|
|
|
Service Code
|
CPT 58671
|
| Hospital Charge Code |
6158671
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.58 |
| 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 |
$660.62
|
| 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 |
$660.62
|
| Rate for Payer: Cash Price |
$660.62
|
| Rate for Payer: Cigna Commercial |
$935.88
|
| Rate for Payer: First Health Commercial |
$990.93
|
| Rate for Payer: First Health Workers Compensation |
$425.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.93
|
| Rate for Payer: GEHA Commercial |
$880.82
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.93
|
| 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 |
$1,001.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$770.72
|
| Rate for Payer: One Health Plan PPO/POS |
$990.93
|
| 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 |
$1,045.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$825.77
|
| 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 |
$1,023.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$440.41
|
| 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 |
$300.58
|
|
|
LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVID
|
Facility
|
IP
|
$1,101.03
|
|
|
Service Code
|
CPT 58671
|
| Hospital Charge Code |
6158671
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.58 |
| Max. Negotiated Rate |
$1,045.98 |
| Rate for Payer: Cash Price |
$660.62
|
| Rate for Payer: Cigna Commercial |
$935.88
|
| Rate for Payer: First Health Commercial |
$990.93
|
| Rate for Payer: First Health Workers Compensation |
$425.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.93
|
| Rate for Payer: GEHA Commercial |
$770.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.93
|
| Rate for Payer: Multiplan All |
$1,001.94
|
| Rate for Payer: OMNI Networks Commercial |
$770.72
|
| Rate for Payer: One Health Plan PPO/POS |
$990.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.98
|
| Rate for Payer: Three Rivers Provider Network All |
$825.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.96
|
| Rate for Payer: Zelis Auto |
$440.41
|
| Rate for Payer: Zelis Worker's Compensation |
$300.58
|
|
