|
LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS
|
Facility
|
OP
|
$2,446.00
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
6158570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$667.76 |
| 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 |
$1,467.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cigna Commercial |
$2,079.10
|
| Rate for Payer: First Health Commercial |
$2,201.40
|
| Rate for Payer: First Health Workers Compensation |
$944.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,201.40
|
| Rate for Payer: GEHA Commercial |
$1,956.80
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,201.40
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,225.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,712.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,201.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,323.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,834.50
|
| 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 |
$2,274.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$978.40
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$667.76
|
|
|
LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS
|
Facility
|
IP
|
$2,446.00
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
6158570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$667.76 |
| Max. Negotiated Rate |
$2,323.70 |
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cigna Commercial |
$2,079.10
|
| Rate for Payer: First Health Commercial |
$2,201.40
|
| Rate for Payer: First Health Workers Compensation |
$944.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,201.40
|
| Rate for Payer: GEHA Commercial |
$1,712.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,201.40
|
| Rate for Payer: Multiplan All |
$2,225.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,712.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,201.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,323.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,834.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,274.78
|
| Rate for Payer: Zelis Auto |
$978.40
|
| Rate for Payer: Zelis Worker's Compensation |
$667.76
|
|
|
LAPARO SLING OPERATION
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT 51992
|
| Hospital Charge Code |
6151992
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.11 |
| 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 |
$1,039.80
|
| 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 |
$5,539.96
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cigna Commercial |
$1,473.05
|
| Rate for Payer: First Health Commercial |
$1,559.70
|
| Rate for Payer: First Health Workers Compensation |
$669.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,559.70
|
| Rate for Payer: GEHA Commercial |
$1,386.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,559.70
|
| 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 |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,577.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,213.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,559.70
|
| 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 |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,646.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.75
|
| 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 |
$1,611.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$693.20
|
| 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 |
$473.11
|
|
|
LAPARO SLING OPERATION
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT 51992
|
| Hospital Charge Code |
6151992
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.11 |
| Max. Negotiated Rate |
$1,646.35 |
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cigna Commercial |
$1,473.05
|
| Rate for Payer: First Health Commercial |
$1,559.70
|
| Rate for Payer: First Health Workers Compensation |
$669.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,559.70
|
| Rate for Payer: GEHA Commercial |
$1,213.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,559.70
|
| Rate for Payer: Multiplan All |
$1,577.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,213.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,559.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,646.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,611.69
|
| Rate for Payer: Zelis Auto |
$693.20
|
| Rate for Payer: Zelis Worker's Compensation |
$473.11
|
|
|
LAPARO SURG, W/ VAG HYST UTERUS > 250 G
|
Facility
|
OP
|
$3,230.13
|
|
|
Service Code
|
CPT 58553
|
| Hospital Charge Code |
6158553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$881.83 |
| 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 |
$1,938.08
|
| 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 |
$1,938.08
|
| Rate for Payer: Cash Price |
$1,938.08
|
| Rate for Payer: Cigna Commercial |
$2,745.61
|
| Rate for Payer: First Health Commercial |
$2,907.12
|
| Rate for Payer: First Health Workers Compensation |
$1,247.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,907.12
|
| Rate for Payer: GEHA Commercial |
$2,584.10
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,907.12
|
| 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 |
$2,939.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,261.09
|
| Rate for Payer: One Health Plan PPO/POS |
$2,907.12
|
| 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 |
$3,068.62
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,422.60
|
| 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 |
$3,004.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,292.05
|
| 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 |
$881.83
|
|
|
LAPARO SURG, W/ VAG HYST UTERUS > 250 G
|
Facility
|
IP
|
$3,230.13
|
|
|
Service Code
|
CPT 58553
|
| Hospital Charge Code |
6158553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$881.83 |
| Max. Negotiated Rate |
$3,068.62 |
| Rate for Payer: Cash Price |
$1,938.08
|
| Rate for Payer: Cigna Commercial |
$2,745.61
|
| Rate for Payer: First Health Commercial |
$2,907.12
|
| Rate for Payer: First Health Workers Compensation |
$1,247.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,907.12
|
| Rate for Payer: GEHA Commercial |
$2,261.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,907.12
|
| Rate for Payer: Multiplan All |
$2,939.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,261.09
|
| Rate for Payer: One Health Plan PPO/POS |
$2,907.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,068.62
|
| Rate for Payer: Three Rivers Provider Network All |
$2,422.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,004.02
|
| Rate for Payer: Zelis Auto |
$1,292.05
|
| Rate for Payer: Zelis Worker's Compensation |
$881.83
|
|
|
LAPARO TOTAL PROCTOCOLECTOMY
|
Facility
|
IP
|
$3,732.00
|
|
|
Service Code
|
CPT 44210
|
| Hospital Charge Code |
6144210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,018.84 |
| Max. Negotiated Rate |
$3,545.40 |
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cigna Commercial |
$3,172.20
|
| Rate for Payer: First Health Commercial |
$3,358.80
|
| Rate for Payer: First Health Workers Compensation |
$1,440.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,358.80
|
| Rate for Payer: GEHA Commercial |
$2,612.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,358.80
|
| Rate for Payer: Multiplan All |
$3,396.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,612.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,358.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,545.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,799.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,470.76
|
| Rate for Payer: Zelis Auto |
$1,492.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,018.84
|
|
|
LAPARO TOTAL PROCTOCOLECTOMY
|
Facility
|
OP
|
$4,280.00
|
|
|
Service Code
|
CPT 44212
|
| Hospital Charge Code |
6144212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,070.00 |
| Max. Negotiated Rate |
$4,066.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,568.00
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$3,638.00
|
| Rate for Payer: First Health Commercial |
$3,852.00
|
| Rate for Payer: First Health Workers Compensation |
$1,652.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,852.00
|
| Rate for Payer: GEHA Commercial |
$3,424.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,852.00
|
| Rate for Payer: Humana ChoiceCare |
$1,112.80
|
| Rate for Payer: Multiplan All |
$3,894.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,568.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,996.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,852.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,066.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,766.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,070.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,980.40
|
| Rate for Payer: Zelis Auto |
$1,712.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,168.44
|
|
|
LAPARO TOTAL PROCTOCOLECTOMY
|
Facility
|
OP
|
$3,732.00
|
|
|
Service Code
|
CPT 44210
|
| Hospital Charge Code |
6144210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$933.00 |
| Max. Negotiated Rate |
$3,545.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cigna Commercial |
$3,172.20
|
| Rate for Payer: First Health Commercial |
$3,358.80
|
| Rate for Payer: First Health Workers Compensation |
$1,440.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,358.80
|
| Rate for Payer: GEHA Commercial |
$2,985.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,358.80
|
| Rate for Payer: Humana ChoiceCare |
$970.32
|
| Rate for Payer: Multiplan All |
$3,396.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,239.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,612.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,358.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,545.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,799.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,284.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,470.76
|
| Rate for Payer: Zelis Auto |
$1,492.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,866.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,018.84
|
|
|
LAPARO TOTAL PROCTOCOLECTOMY
|
Facility
|
IP
|
$4,280.00
|
|
|
Service Code
|
CPT 44212
|
| Hospital Charge Code |
6144212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,168.44 |
| Max. Negotiated Rate |
$4,066.00 |
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$3,638.00
|
| Rate for Payer: First Health Commercial |
$3,852.00
|
| Rate for Payer: First Health Workers Compensation |
$1,652.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,852.00
|
| Rate for Payer: GEHA Commercial |
$2,996.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,852.00
|
| Rate for Payer: Multiplan All |
$3,894.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,996.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,852.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,066.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,980.40
|
| Rate for Payer: Zelis Auto |
$1,712.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,168.44
|
|
|
LAPARO URETHRAL SUSPENSION
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 51990
|
| Hospital Charge Code |
6151990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.51 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$926.40
|
| 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 |
$926.40
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cigna Commercial |
$1,312.40
|
| Rate for Payer: First Health Commercial |
$1,389.60
|
| Rate for Payer: First Health Workers Compensation |
$596.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,389.60
|
| Rate for Payer: GEHA Commercial |
$1,235.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,389.60
|
| 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 |
$1,405.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,389.60
|
| 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 |
$1,466.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,158.00
|
| 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 |
$1,435.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$617.60
|
| 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 |
$421.51
|
|
|
LAPARO URETHRAL SUSPENSION
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 51990
|
| Hospital Charge Code |
6151990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.51 |
| Max. Negotiated Rate |
$1,466.80 |
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cigna Commercial |
$1,312.40
|
| Rate for Payer: First Health Commercial |
$1,389.60
|
| Rate for Payer: First Health Workers Compensation |
$596.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,389.60
|
| Rate for Payer: GEHA Commercial |
$1,080.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,389.60
|
| Rate for Payer: Multiplan All |
$1,405.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,389.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,466.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,435.92
|
| Rate for Payer: Zelis Auto |
$617.60
|
| Rate for Payer: Zelis Worker's Compensation |
$421.51
|
|
|
LAP, CHANGE ADJUST GAST BAND
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
CPT 43773
|
| Hospital Charge Code |
6143773
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$727.82 |
| Max. Negotiated Rate |
$2,532.70 |
| Rate for Payer: Cash Price |
$1,599.60
|
| Rate for Payer: Cigna Commercial |
$2,266.10
|
| Rate for Payer: First Health Commercial |
$2,399.40
|
| Rate for Payer: First Health Workers Compensation |
$1,029.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,399.40
|
| Rate for Payer: GEHA Commercial |
$1,866.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,399.40
|
| Rate for Payer: Multiplan All |
$2,426.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,866.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,399.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,532.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,999.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,479.38
|
| Rate for Payer: Zelis Auto |
$1,066.40
|
| Rate for Payer: Zelis Worker's Compensation |
$727.82
|
|
|
LAP, CHANGE ADJUST GAST BAND
|
Facility
|
OP
|
$2,666.00
|
|
|
Service Code
|
CPT 43773
|
| Hospital Charge Code |
6143773
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$727.82 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,531.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,599.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,531.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,173.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$1,599.60
|
| Rate for Payer: Cash Price |
$1,599.60
|
| Rate for Payer: Cigna Commercial |
$2,266.10
|
| Rate for Payer: First Health Commercial |
$2,399.40
|
| Rate for Payer: First Health Workers Compensation |
$1,029.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,399.40
|
| Rate for Payer: GEHA Commercial |
$2,132.80
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,399.40
|
| 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 |
$5,279.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$2,426.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,866.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,399.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,095.63
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,279.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,532.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,999.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,279.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,479.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$1,066.40
|
| 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 |
$727.82
|
|
|
LAP, CLOSE ENTEROSTOMY
|
Facility
|
IP
|
$3,514.00
|
|
|
Service Code
|
CPT 44227
|
| Hospital Charge Code |
6144227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$959.32 |
| Max. Negotiated Rate |
$3,338.30 |
| Rate for Payer: Cash Price |
$2,108.40
|
| Rate for Payer: Cigna Commercial |
$2,986.90
|
| Rate for Payer: First Health Commercial |
$3,162.60
|
| Rate for Payer: First Health Workers Compensation |
$1,356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,162.60
|
| Rate for Payer: GEHA Commercial |
$2,459.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,162.60
|
| Rate for Payer: Multiplan All |
$3,197.74
|
| Rate for Payer: OMNI Networks Commercial |
$2,459.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,162.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,338.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,635.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,268.02
|
| Rate for Payer: Zelis Auto |
$1,405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$959.32
|
|
|
LAP, CLOSE ENTEROSTOMY
|
Facility
|
OP
|
$3,514.00
|
|
|
Service Code
|
CPT 44227
|
| Hospital Charge Code |
6144227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$878.50 |
| Max. Negotiated Rate |
$3,338.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,108.40
|
| Rate for Payer: Cash Price |
$2,108.40
|
| Rate for Payer: Cigna Commercial |
$2,986.90
|
| Rate for Payer: First Health Commercial |
$3,162.60
|
| Rate for Payer: First Health Workers Compensation |
$1,356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,162.60
|
| Rate for Payer: GEHA Commercial |
$2,811.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,162.60
|
| Rate for Payer: Humana ChoiceCare |
$913.64
|
| Rate for Payer: Multiplan All |
$3,197.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,108.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,459.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,162.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,338.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,635.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,092.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$878.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,268.02
|
| Rate for Payer: Zelis Auto |
$1,405.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,757.00
|
| Rate for Payer: Zelis Worker's Compensation |
$959.32
|
|
|
LAP COLECTOMY PART W/ILEUM
|
Facility
|
OP
|
$2,816.00
|
|
|
Service Code
|
CPT 44205
|
| Hospital Charge Code |
6144205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$2,675.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,689.60
|
| Rate for Payer: Cash Price |
$1,689.60
|
| Rate for Payer: Cigna Commercial |
$2,393.60
|
| Rate for Payer: First Health Commercial |
$2,534.40
|
| Rate for Payer: First Health Workers Compensation |
$1,087.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,534.40
|
| Rate for Payer: GEHA Commercial |
$2,252.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,534.40
|
| Rate for Payer: Humana ChoiceCare |
$732.16
|
| Rate for Payer: Multiplan All |
$2,562.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,689.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,534.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,675.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,478.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$704.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,618.88
|
| Rate for Payer: Zelis Auto |
$1,126.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,408.00
|
| Rate for Payer: Zelis Worker's Compensation |
$768.77
|
|
|
LAP COLECTOMY PART W/ILEUM
|
Facility
|
IP
|
$2,816.00
|
|
|
Service Code
|
CPT 44205
|
| Hospital Charge Code |
6144205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$768.77 |
| Max. Negotiated Rate |
$2,675.20 |
| Rate for Payer: Cash Price |
$1,689.60
|
| Rate for Payer: Cigna Commercial |
$2,393.60
|
| Rate for Payer: First Health Commercial |
$2,534.40
|
| Rate for Payer: First Health Workers Compensation |
$1,087.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,534.40
|
| Rate for Payer: GEHA Commercial |
$1,971.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,534.40
|
| Rate for Payer: Multiplan All |
$2,562.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,534.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,675.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,618.88
|
| Rate for Payer: Zelis Auto |
$1,126.40
|
| Rate for Payer: Zelis Worker's Compensation |
$768.77
|
|
|
LAP COLECTOMY W/PROCTECTOMY
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 44211
|
| Hospital Charge Code |
6144211
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$4,339.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,740.80
|
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cigna Commercial |
$3,882.80
|
| Rate for Payer: First Health Commercial |
$4,111.20
|
| Rate for Payer: First Health Workers Compensation |
$1,763.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,111.20
|
| Rate for Payer: GEHA Commercial |
$3,654.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,111.20
|
| Rate for Payer: Humana ChoiceCare |
$1,187.68
|
| Rate for Payer: Multiplan All |
$4,156.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,740.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,197.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,111.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,339.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,426.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,019.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,142.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,248.24
|
| Rate for Payer: Zelis Auto |
$1,827.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,284.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,247.06
|
|
|
LAP COLECTOMY W/PROCTECTOMY
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
CPT 44211
|
| Hospital Charge Code |
6144211
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,247.06 |
| Max. Negotiated Rate |
$4,339.60 |
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cigna Commercial |
$3,882.80
|
| Rate for Payer: First Health Commercial |
$4,111.20
|
| Rate for Payer: First Health Workers Compensation |
$1,763.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,111.20
|
| Rate for Payer: GEHA Commercial |
$3,197.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,111.20
|
| Rate for Payer: Multiplan All |
$4,156.88
|
| Rate for Payer: OMNI Networks Commercial |
$3,197.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,111.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,339.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,248.24
|
| Rate for Payer: Zelis Auto |
$1,827.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,247.06
|
|
|
LAP, COLOSTOMY
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
CPT 44188
|
| Hospital Charge Code |
6144188
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$699.70 |
| Max. Negotiated Rate |
$2,434.85 |
| Rate for Payer: Cash Price |
$1,537.80
|
| Rate for Payer: Cigna Commercial |
$2,178.55
|
| Rate for Payer: First Health Commercial |
$2,306.70
|
| Rate for Payer: First Health Workers Compensation |
$989.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,306.70
|
| Rate for Payer: GEHA Commercial |
$1,794.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,306.70
|
| Rate for Payer: Multiplan All |
$2,332.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,794.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,306.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,434.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,922.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,383.59
|
| Rate for Payer: Zelis Auto |
$1,025.20
|
| Rate for Payer: Zelis Worker's Compensation |
$699.70
|
|
|
LAP, COLOSTOMY
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
CPT 44188
|
| Hospital Charge Code |
6144188
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$640.75 |
| Max. Negotiated Rate |
$2,434.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,537.80
|
| Rate for Payer: Cash Price |
$1,537.80
|
| Rate for Payer: Cigna Commercial |
$2,178.55
|
| Rate for Payer: First Health Commercial |
$2,306.70
|
| Rate for Payer: First Health Workers Compensation |
$989.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,306.70
|
| Rate for Payer: GEHA Commercial |
$2,050.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,306.70
|
| Rate for Payer: Humana ChoiceCare |
$666.38
|
| Rate for Payer: Multiplan All |
$2,332.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,537.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,794.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,306.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,434.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,922.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,255.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$640.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,383.59
|
| Rate for Payer: Zelis Auto |
$1,025.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,281.50
|
| Rate for Payer: Zelis Worker's Compensation |
$699.70
|
|
|
LAP, ENTERECTOMY
|
Facility
|
OP
|
$2,922.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
6144202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$730.50 |
| Max. Negotiated Rate |
$2,775.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,753.20
|
| Rate for Payer: Cash Price |
$1,753.20
|
| Rate for Payer: Cigna Commercial |
$2,483.70
|
| Rate for Payer: First Health Commercial |
$2,629.80
|
| Rate for Payer: First Health Workers Compensation |
$1,128.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,629.80
|
| Rate for Payer: GEHA Commercial |
$2,337.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,629.80
|
| Rate for Payer: Humana ChoiceCare |
$759.72
|
| Rate for Payer: Multiplan All |
$2,659.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,753.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,045.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,629.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,775.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,191.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,571.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$730.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,717.46
|
| Rate for Payer: Zelis Auto |
$1,168.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,461.00
|
| Rate for Payer: Zelis Worker's Compensation |
$797.71
|
|
|
LAP, ENTERECTOMY
|
Facility
|
IP
|
$2,922.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
6144202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$797.71 |
| Max. Negotiated Rate |
$2,775.90 |
| Rate for Payer: Cash Price |
$1,753.20
|
| Rate for Payer: Cigna Commercial |
$2,483.70
|
| Rate for Payer: First Health Commercial |
$2,629.80
|
| Rate for Payer: First Health Workers Compensation |
$1,128.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,629.80
|
| Rate for Payer: GEHA Commercial |
$2,045.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,629.80
|
| Rate for Payer: Multiplan All |
$2,659.02
|
| Rate for Payer: OMNI Networks Commercial |
$2,045.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,629.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,775.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,191.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,717.46
|
| Rate for Payer: Zelis Auto |
$1,168.80
|
| Rate for Payer: Zelis Worker's Compensation |
$797.71
|
|
|
LAP ESOPH LENGTHENING
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 43283
|
| Hospital Charge Code |
6143283
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
