|
LAP ESOPH LENGTHENING
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 43283
|
| Hospital Charge Code |
6143283
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| 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 |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
LAP GASTR BYPASS INCL SMLL I
|
Facility
|
OP
|
$3,909.00
|
|
|
Service Code
|
CPT 43645
|
| Hospital Charge Code |
6143645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$977.25 |
| Max. Negotiated Rate |
$3,713.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,345.40
|
| Rate for Payer: Cash Price |
$2,345.40
|
| Rate for Payer: Cigna Commercial |
$3,322.65
|
| Rate for Payer: First Health Commercial |
$3,518.10
|
| Rate for Payer: First Health Workers Compensation |
$1,509.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,518.10
|
| Rate for Payer: GEHA Commercial |
$3,127.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,518.10
|
| Rate for Payer: Humana ChoiceCare |
$1,016.34
|
| Rate for Payer: Multiplan All |
$3,557.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,345.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,736.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,518.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,713.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,931.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,439.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$977.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,635.37
|
| Rate for Payer: Zelis Auto |
$1,563.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,954.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,067.16
|
|
|
LAP GASTR BYPASS INCL SMLL I
|
Facility
|
IP
|
$3,909.00
|
|
|
Service Code
|
CPT 43645
|
| Hospital Charge Code |
6143645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,067.16 |
| Max. Negotiated Rate |
$3,713.55 |
| Rate for Payer: Cash Price |
$2,345.40
|
| Rate for Payer: Cigna Commercial |
$3,322.65
|
| Rate for Payer: First Health Commercial |
$3,518.10
|
| Rate for Payer: First Health Workers Compensation |
$1,509.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,518.10
|
| Rate for Payer: GEHA Commercial |
$2,736.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,518.10
|
| Rate for Payer: Multiplan All |
$3,557.19
|
| Rate for Payer: OMNI Networks Commercial |
$2,736.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,518.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,713.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,931.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,635.37
|
| Rate for Payer: Zelis Auto |
$1,563.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,067.16
|
|
|
LAP GASTRIC BYPASS/ROUX-EN-Y
|
Facility
|
IP
|
$3,655.00
|
|
|
Service Code
|
CPT 43644
|
| Hospital Charge Code |
6143644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$997.82 |
| Max. Negotiated Rate |
$3,472.25 |
| Rate for Payer: Cash Price |
$2,193.00
|
| Rate for Payer: Cigna Commercial |
$3,106.75
|
| Rate for Payer: First Health Commercial |
$3,289.50
|
| Rate for Payer: First Health Workers Compensation |
$1,411.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,289.50
|
| Rate for Payer: GEHA Commercial |
$2,558.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,289.50
|
| Rate for Payer: Multiplan All |
$3,326.05
|
| Rate for Payer: OMNI Networks Commercial |
$2,558.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,289.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,472.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,741.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,399.15
|
| Rate for Payer: Zelis Auto |
$1,462.00
|
| Rate for Payer: Zelis Worker's Compensation |
$997.82
|
|
|
LAP GASTRIC BYPASS/ROUX-EN-Y
|
Facility
|
OP
|
$3,655.00
|
|
|
Service Code
|
CPT 43644
|
| Hospital Charge Code |
6143644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$913.75 |
| Max. Negotiated Rate |
$3,472.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,193.00
|
| Rate for Payer: Cash Price |
$2,193.00
|
| Rate for Payer: Cigna Commercial |
$3,106.75
|
| Rate for Payer: First Health Commercial |
$3,289.50
|
| Rate for Payer: First Health Workers Compensation |
$1,411.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,289.50
|
| Rate for Payer: GEHA Commercial |
$2,924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,289.50
|
| Rate for Payer: Humana ChoiceCare |
$950.30
|
| Rate for Payer: Multiplan All |
$3,326.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,193.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,558.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,289.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,472.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,741.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,216.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,399.15
|
| Rate for Payer: Zelis Auto |
$1,462.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.50
|
| Rate for Payer: Zelis Worker's Compensation |
$997.82
|
|
|
LAP, ILEO/JEJUNO-STOMY
|
Facility
|
IP
|
$2,306.00
|
|
|
Service Code
|
CPT 44187
|
| Hospital Charge Code |
6144187
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$629.54 |
| Max. Negotiated Rate |
$2,190.70 |
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$1,960.10
|
| Rate for Payer: First Health Commercial |
$2,075.40
|
| Rate for Payer: First Health Workers Compensation |
$890.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,075.40
|
| Rate for Payer: GEHA Commercial |
$1,614.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,075.40
|
| Rate for Payer: Multiplan All |
$2,098.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,614.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,075.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,190.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,729.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,144.58
|
| Rate for Payer: Zelis Auto |
$922.40
|
| Rate for Payer: Zelis Worker's Compensation |
$629.54
|
|
|
LAP, ILEO/JEJUNO-STOMY
|
Facility
|
OP
|
$2,306.00
|
|
|
Service Code
|
CPT 44187
|
| Hospital Charge Code |
6144187
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.50 |
| Max. Negotiated Rate |
$2,190.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$1,960.10
|
| Rate for Payer: First Health Commercial |
$2,075.40
|
| Rate for Payer: First Health Workers Compensation |
$890.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,075.40
|
| Rate for Payer: GEHA Commercial |
$1,844.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,075.40
|
| Rate for Payer: Humana ChoiceCare |
$599.56
|
| Rate for Payer: Multiplan All |
$2,098.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,383.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,614.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,075.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,190.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,729.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,029.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$576.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,144.58
|
| Rate for Payer: Zelis Auto |
$922.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,153.00
|
| Rate for Payer: Zelis Worker's Compensation |
$629.54
|
|
|
LAP INC HERNIA REPAIR
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
CPT 49654
|
| Hospital Charge Code |
6149654
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$443.75 |
| Max. Negotiated Rate |
$1,686.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,065.00
|
| Rate for Payer: Cash Price |
$1,065.00
|
| Rate for Payer: Cigna Commercial |
$1,508.75
|
| Rate for Payer: First Health Commercial |
$1,597.50
|
| Rate for Payer: First Health Workers Compensation |
$685.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,597.50
|
| Rate for Payer: GEHA Commercial |
$1,420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,597.50
|
| Rate for Payer: Humana ChoiceCare |
$461.50
|
| Rate for Payer: Multiplan All |
$1,615.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,065.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,242.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,597.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,686.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,331.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,562.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$443.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,650.75
|
| Rate for Payer: Zelis Auto |
$710.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$887.50
|
| Rate for Payer: Zelis Worker's Compensation |
$484.57
|
|
|
LAP INC HERNIA REPAIR
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
CPT 49654
|
| Hospital Charge Code |
6149654
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$484.57 |
| Max. Negotiated Rate |
$1,686.25 |
| Rate for Payer: Cash Price |
$1,065.00
|
| Rate for Payer: Cigna Commercial |
$1,508.75
|
| Rate for Payer: First Health Commercial |
$1,597.50
|
| Rate for Payer: First Health Workers Compensation |
$685.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,597.50
|
| Rate for Payer: GEHA Commercial |
$1,242.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,597.50
|
| Rate for Payer: Multiplan All |
$1,615.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,242.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,597.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,686.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,331.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,650.75
|
| Rate for Payer: Zelis Auto |
$710.00
|
| Rate for Payer: Zelis Worker's Compensation |
$484.57
|
|
|
LAP INC HERNIA REPAIR RECUR
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 49656
|
| Hospital Charge Code |
6149656
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.50 |
| Max. Negotiated Rate |
$1,833.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,158.00
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cigna Commercial |
$1,640.50
|
| Rate for Payer: First Health Commercial |
$1,737.00
|
| Rate for Payer: First Health Workers Compensation |
$745.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.00
|
| Rate for Payer: GEHA Commercial |
$1,544.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.00
|
| Rate for Payer: Humana ChoiceCare |
$501.80
|
| Rate for Payer: Multiplan All |
$1,756.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,833.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,447.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,698.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$482.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,794.90
|
| Rate for Payer: Zelis Auto |
$772.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$965.00
|
| Rate for Payer: Zelis Worker's Compensation |
$526.89
|
|
|
LAP INC HERNIA REPAIR RECUR
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 49656
|
| Hospital Charge Code |
6149656
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$526.89 |
| Max. Negotiated Rate |
$1,833.50 |
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cigna Commercial |
$1,640.50
|
| Rate for Payer: First Health Commercial |
$1,737.00
|
| Rate for Payer: First Health Workers Compensation |
$745.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.00
|
| Rate for Payer: GEHA Commercial |
$1,351.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.00
|
| Rate for Payer: Multiplan All |
$1,756.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,833.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,447.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,794.90
|
| Rate for Payer: Zelis Auto |
$772.00
|
| Rate for Payer: Zelis Worker's Compensation |
$526.89
|
|
|
LAP INC HERN RECUR COMP
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
CPT 49657
|
| Hospital Charge Code |
6149657
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$758.39 |
| Max. Negotiated Rate |
$2,639.10 |
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cigna Commercial |
$2,361.30
|
| Rate for Payer: First Health Commercial |
$2,500.20
|
| Rate for Payer: First Health Workers Compensation |
$1,072.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,500.20
|
| Rate for Payer: GEHA Commercial |
$1,944.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,500.20
|
| Rate for Payer: Multiplan All |
$2,527.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,944.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,500.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,639.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,083.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,583.54
|
| Rate for Payer: Zelis Auto |
$1,111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$758.39
|
|
|
LAP INC HERN RECUR COMP
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
CPT 49657
|
| Hospital Charge Code |
6149657
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$694.50 |
| Max. Negotiated Rate |
$2,639.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,666.80
|
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cigna Commercial |
$2,361.30
|
| Rate for Payer: First Health Commercial |
$2,500.20
|
| Rate for Payer: First Health Workers Compensation |
$1,072.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,500.20
|
| Rate for Payer: GEHA Commercial |
$2,222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,500.20
|
| Rate for Payer: Humana ChoiceCare |
$722.28
|
| Rate for Payer: Multiplan All |
$2,527.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,666.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,944.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,500.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,639.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,083.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,444.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,583.54
|
| Rate for Payer: Zelis Auto |
$1,111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,389.00
|
| Rate for Payer: Zelis Worker's Compensation |
$758.39
|
|
|
LAP INC HERN REPAIR COMP
|
Facility
|
OP
|
$2,168.00
|
|
|
Service Code
|
CPT 49655
|
| Hospital Charge Code |
6149655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$542.00 |
| Max. Negotiated Rate |
$2,059.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cigna Commercial |
$1,842.80
|
| Rate for Payer: First Health Commercial |
$1,951.20
|
| Rate for Payer: First Health Workers Compensation |
$837.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,951.20
|
| Rate for Payer: GEHA Commercial |
$1,734.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,951.20
|
| Rate for Payer: Humana ChoiceCare |
$563.68
|
| Rate for Payer: Multiplan All |
$1,972.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,300.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,517.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,951.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,059.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,626.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,907.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$542.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,016.24
|
| Rate for Payer: Zelis Auto |
$867.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,084.00
|
| Rate for Payer: Zelis Worker's Compensation |
$591.86
|
|
|
LAP INC HERN REPAIR COMP
|
Facility
|
IP
|
$2,168.00
|
|
|
Service Code
|
CPT 49655
|
| Hospital Charge Code |
6149655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$591.86 |
| Max. Negotiated Rate |
$2,059.60 |
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cigna Commercial |
$1,842.80
|
| Rate for Payer: First Health Commercial |
$1,951.20
|
| Rate for Payer: First Health Workers Compensation |
$837.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,951.20
|
| Rate for Payer: GEHA Commercial |
$1,517.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,951.20
|
| Rate for Payer: Multiplan All |
$1,972.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,517.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,951.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,059.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,626.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,016.24
|
| Rate for Payer: Zelis Auto |
$867.20
|
| Rate for Payer: Zelis Worker's Compensation |
$591.86
|
|
|
LAP ING HERNIA REPAIR INIT
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
6149650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$624.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| Rate for Payer: Multiplan All |
$811.72
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$847.40
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$829.56
|
| Rate for Payer: Zelis Auto |
$356.80
|
| Rate for Payer: Zelis Worker's Compensation |
$243.52
|
|
|
LAP ING HERNIA REPAIR INIT
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
6149650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| 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 |
$535.20
|
| 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 |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$713.60
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| 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 |
$811.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| 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 |
$847.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| 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 |
$829.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$356.80
|
| 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 |
$243.52
|
|
|
LAP ING HERNIA REPAIR RECUR
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
6149651
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| 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 |
$696.00
|
| 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 |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$928.00
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| 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 |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| 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 |
$1,102.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| 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 |
$1,078.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$464.00
|
| 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 |
$316.68
|
|
|
LAP ING HERNIA REPAIR RECUR
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
6149651
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
LAP INS DEVICE FOR RT
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 49327
|
| Hospital Charge Code |
6149327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$397.10 |
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$355.30
|
| Rate for Payer: First Health Commercial |
$376.20
|
| Rate for Payer: First Health Workers Compensation |
$161.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$376.20
|
| Rate for Payer: GEHA Commercial |
$292.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$376.20
|
| Rate for Payer: Multiplan All |
$380.38
|
| Rate for Payer: OMNI Networks Commercial |
$292.60
|
| Rate for Payer: One Health Plan PPO/POS |
$376.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$397.10
|
| Rate for Payer: Three Rivers Provider Network All |
$313.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$388.74
|
| Rate for Payer: Zelis Auto |
$167.20
|
| Rate for Payer: Zelis Worker's Compensation |
$114.11
|
|
|
LAP INS DEVICE FOR RT
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 49327
|
| Hospital Charge Code |
6149327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$3,908.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,095.93
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$355.30
|
| Rate for Payer: First Health Commercial |
$376.20
|
| Rate for Payer: First Health Workers Compensation |
$161.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$376.20
|
| Rate for Payer: GEHA Commercial |
$334.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$376.20
|
| Rate for Payer: Humana ChoiceCare |
$108.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,158.97
|
| Rate for Payer: Multiplan All |
$380.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$250.80
|
| Rate for Payer: OMNI Networks Commercial |
$292.60
|
| Rate for Payer: One Health Plan PPO/POS |
$376.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,647.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,158.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$397.10
|
| Rate for Payer: Three Rivers Provider Network All |
$313.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$367.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,158.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$388.74
|
| Rate for Payer: Zelis Auto |
$167.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$209.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.11
|
|
|
LAP INSERT TUNNEL IP CATH
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 49324
|
| Hospital Charge Code |
6149324
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| 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 |
$490.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,048.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$654.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,110.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,591.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,110.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| 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 |
$760.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$327.20
|
| 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 |
$223.31
|
|
|
LAP INSERT TUNNEL IP CATH
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 49324
|
| Hospital Charge Code |
6149324
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| Max. Negotiated Rate |
$777.10 |
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$572.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$760.74
|
| Rate for Payer: Zelis Auto |
$327.20
|
| Rate for Payer: Zelis Worker's Compensation |
$223.31
|
|
|
LAPIPLASTY MINI-INCISION
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Humana ChoiceCare |
$1,560.00
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,600.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,280.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,000.00
|
|
|
LAPIPLASTY MINI-INCISION
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,400.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,800.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
|
