|
LAP RESECT S/INTESTINE, ADDL
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 44203
|
| Hospital Charge Code |
6144203
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
LAP, REVISE ADJUST GAST BAND
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
CPT 43771
|
| Hospital Charge Code |
6143771
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$669.50 |
| Max. Negotiated Rate |
$2,544.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cigna Commercial |
$2,276.30
|
| Rate for Payer: First Health Commercial |
$2,410.20
|
| Rate for Payer: First Health Workers Compensation |
$1,033.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,410.20
|
| Rate for Payer: GEHA Commercial |
$2,142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,410.20
|
| Rate for Payer: Humana ChoiceCare |
$696.28
|
| Rate for Payer: Multiplan All |
$2,436.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,606.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,874.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,410.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,544.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,008.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,356.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$669.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,490.54
|
| Rate for Payer: Zelis Auto |
$1,071.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,339.00
|
| Rate for Payer: Zelis Worker's Compensation |
$731.09
|
|
|
LAP, REVISE ADJUST GAST BAND
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
CPT 43771
|
| Hospital Charge Code |
6143771
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$731.09 |
| Max. Negotiated Rate |
$2,544.10 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cigna Commercial |
$2,276.30
|
| Rate for Payer: First Health Commercial |
$2,410.20
|
| Rate for Payer: First Health Workers Compensation |
$1,033.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,410.20
|
| Rate for Payer: GEHA Commercial |
$1,874.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,410.20
|
| Rate for Payer: Multiplan All |
$2,436.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,874.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,410.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,544.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,008.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,490.54
|
| Rate for Payer: Zelis Auto |
$1,071.20
|
| Rate for Payer: Zelis Worker's Compensation |
$731.09
|
|
|
LAP REVISION PERM IP CATH
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT 49325
|
| Hospital Charge Code |
6149325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.60 |
| 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 |
$524.40
|
| 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 |
$5,539.96
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$699.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| 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 |
$3,110.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| 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 |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| 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 |
$812.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$349.60
|
| 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 |
$238.60
|
|
|
LAP REVISION PERM IP CATH
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 49325
|
| Hospital Charge Code |
6149325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$611.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
6149320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$805.60 |
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: First Health Commercial |
$763.20
|
| Rate for Payer: First Health Workers Compensation |
$327.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$763.20
|
| Rate for Payer: GEHA Commercial |
$593.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$763.20
|
| Rate for Payer: Multiplan All |
$771.68
|
| Rate for Payer: OMNI Networks Commercial |
$593.60
|
| Rate for Payer: One Health Plan PPO/POS |
$763.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$805.60
|
| Rate for Payer: Three Rivers Provider Network All |
$636.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$788.64
|
| Rate for Payer: Zelis Auto |
$339.20
|
| Rate for Payer: Zelis Worker's Compensation |
$231.50
|
|
|
LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
6149320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.50 |
| 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 |
$508.80
|
| 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 |
$508.80
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: First Health Commercial |
$763.20
|
| Rate for Payer: First Health Workers Compensation |
$327.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$763.20
|
| Rate for Payer: GEHA Commercial |
$678.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$763.20
|
| 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 |
$771.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$593.60
|
| Rate for Payer: One Health Plan PPO/POS |
$763.20
|
| 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 |
$805.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$636.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,110.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$788.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$339.20
|
| 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 |
$231.50
|
|
|
LAPS ABLT UTERINE FIBROIDS
|
Facility
|
OP
|
$10,607.00
|
|
|
Service Code
|
CPT 58674
|
| Hospital Charge Code |
6191072
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,895.71 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10,450.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,364.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10,450.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,278.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$6,364.20
|
| Rate for Payer: Cash Price |
$6,364.20
|
| Rate for Payer: Cigna Commercial |
$9,015.95
|
| Rate for Payer: First Health Commercial |
$9,546.30
|
| Rate for Payer: First Health Workers Compensation |
$4,095.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,546.30
|
| Rate for Payer: GEHA Commercial |
$8,485.60
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,546.30
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,447.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$9,652.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$7,424.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,546.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9,753.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,447.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,076.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$7,955.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,447.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,864.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$4,242.80
|
| 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 |
$2,895.71
|
|
|
LAPS ABLT UTERINE FIBROIDS
|
Facility
|
IP
|
$10,607.00
|
|
|
Service Code
|
CPT 58674
|
| Hospital Charge Code |
6191072
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,895.71 |
| Max. Negotiated Rate |
$10,076.65 |
| Rate for Payer: Cash Price |
$6,364.20
|
| Rate for Payer: Cigna Commercial |
$9,015.95
|
| Rate for Payer: First Health Commercial |
$9,546.30
|
| Rate for Payer: First Health Workers Compensation |
$4,095.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,546.30
|
| Rate for Payer: GEHA Commercial |
$7,424.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,546.30
|
| Rate for Payer: Multiplan All |
$9,652.37
|
| Rate for Payer: OMNI Networks Commercial |
$7,424.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,546.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,076.65
|
| Rate for Payer: Three Rivers Provider Network All |
$7,955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,864.51
|
| Rate for Payer: Zelis Auto |
$4,242.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,895.71
|
|
|
LAPS ESOPHGL SPHNCTR AGMNT
|
Facility
|
IP
|
$10,607.00
|
|
|
Service Code
|
CPT 43284
|
| Hospital Charge Code |
6191073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,895.71 |
| Max. Negotiated Rate |
$10,076.65 |
| Rate for Payer: Cash Price |
$6,364.20
|
| Rate for Payer: Cigna Commercial |
$9,015.95
|
| Rate for Payer: First Health Commercial |
$9,546.30
|
| Rate for Payer: First Health Workers Compensation |
$4,095.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,546.30
|
| Rate for Payer: GEHA Commercial |
$7,424.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,546.30
|
| Rate for Payer: Multiplan All |
$9,652.37
|
| Rate for Payer: OMNI Networks Commercial |
$7,424.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,546.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,076.65
|
| Rate for Payer: Three Rivers Provider Network All |
$7,955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,864.51
|
| Rate for Payer: Zelis Auto |
$4,242.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,895.71
|
|
|
LAPS ESOPHGL SPHNCTR AGMNT
|
Facility
|
OP
|
$10,607.00
|
|
|
Service Code
|
CPT 43284
|
| Hospital Charge Code |
6191073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,895.71 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10,450.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,364.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10,450.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,278.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$6,364.20
|
| Rate for Payer: Cash Price |
$6,364.20
|
| Rate for Payer: Cigna Commercial |
$9,015.95
|
| Rate for Payer: First Health Commercial |
$9,546.30
|
| Rate for Payer: First Health Workers Compensation |
$4,095.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,546.30
|
| Rate for Payer: GEHA Commercial |
$8,485.60
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,546.30
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,447.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$9,652.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$7,424.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,546.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9,753.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,447.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,076.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$7,955.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,447.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,864.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$4,242.80
|
| 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 |
$2,895.71
|
|
|
LAPS FULG/EXC OVARY VISCERA/PERITONEAL
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
6158662
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.33 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna Commercial |
$1,878.50
|
| Rate for Payer: First Health Commercial |
$1,989.00
|
| Rate for Payer: First Health Workers Compensation |
$853.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,989.00
|
| Rate for Payer: GEHA Commercial |
$1,547.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,989.00
|
| Rate for Payer: Multiplan All |
$2,011.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,547.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,989.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,099.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,657.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,055.30
|
| Rate for Payer: Zelis Auto |
$884.00
|
| Rate for Payer: Zelis Worker's Compensation |
$603.33
|
|
|
LAPS FULG/EXC OVARY VISCERA/PERITONEAL
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
6158662
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.33 |
| 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 |
$1,326.00
|
| 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 |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna Commercial |
$1,878.50
|
| Rate for Payer: First Health Commercial |
$1,989.00
|
| Rate for Payer: First Health Workers Compensation |
$853.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,989.00
|
| Rate for Payer: GEHA Commercial |
$1,768.00
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,989.00
|
| 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 |
$2,011.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,547.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,989.00
|
| 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 |
$2,099.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,657.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,055.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$884.00
|
| 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 |
$603.33
|
|
|
LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Facility
|
OP
|
$893.17
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
6158545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.84 |
| 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 |
$535.90
|
| 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 |
$535.90
|
| Rate for Payer: Cash Price |
$535.90
|
| Rate for Payer: Cigna Commercial |
$759.19
|
| Rate for Payer: First Health Commercial |
$803.85
|
| Rate for Payer: First Health Workers Compensation |
$344.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.85
|
| Rate for Payer: GEHA Commercial |
$714.54
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.85
|
| 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 |
$812.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$625.22
|
| Rate for Payer: One Health Plan PPO/POS |
$803.85
|
| 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 |
$848.51
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$669.88
|
| 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 |
$830.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$357.27
|
| 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 |
$243.84
|
|
|
LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Facility
|
IP
|
$893.17
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
6158545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.84 |
| Max. Negotiated Rate |
$848.51 |
| Rate for Payer: Cash Price |
$535.90
|
| Rate for Payer: Cigna Commercial |
$759.19
|
| Rate for Payer: First Health Commercial |
$803.85
|
| Rate for Payer: First Health Workers Compensation |
$344.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.85
|
| Rate for Payer: GEHA Commercial |
$625.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.85
|
| Rate for Payer: Multiplan All |
$812.78
|
| Rate for Payer: OMNI Networks Commercial |
$625.22
|
| Rate for Payer: One Health Plan PPO/POS |
$803.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.51
|
| Rate for Payer: Three Rivers Provider Network All |
$669.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.65
|
| Rate for Payer: Zelis Auto |
$357.27
|
| Rate for Payer: Zelis Worker's Compensation |
$243.84
|
|
|
LAPS PELVIC LYMPHADEC
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 38573
|
| Hospital Charge Code |
6169671
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
LAPS PELVIC LYMPHADEC
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 38573
|
| Hospital Charge Code |
6169671
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,392.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,392.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,025.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,208.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,632.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,208.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,208.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TU
|
Facility
|
OP
|
$2,538.00
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
6158542
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$692.87 |
| 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 |
$1,522.80
|
| 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 |
$1,522.80
|
| Rate for Payer: Cash Price |
$1,522.80
|
| Rate for Payer: Cigna Commercial |
$2,157.30
|
| Rate for Payer: First Health Commercial |
$2,284.20
|
| Rate for Payer: First Health Workers Compensation |
$979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,284.20
|
| Rate for Payer: GEHA Commercial |
$2,030.40
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,284.20
|
| 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 |
$2,309.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,776.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,284.20
|
| 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 |
$2,411.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,903.50
|
| 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 |
$2,360.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,015.20
|
| 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 |
$692.87
|
|
|
LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TU
|
Facility
|
IP
|
$2,538.00
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
6158542
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$692.87 |
| Max. Negotiated Rate |
$2,411.10 |
| Rate for Payer: Cash Price |
$1,522.80
|
| Rate for Payer: Cigna Commercial |
$2,157.30
|
| Rate for Payer: First Health Commercial |
$2,284.20
|
| Rate for Payer: First Health Workers Compensation |
$979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,284.20
|
| Rate for Payer: GEHA Commercial |
$1,776.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,284.20
|
| Rate for Payer: Multiplan All |
$2,309.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,776.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,284.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,411.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,903.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,360.34
|
| Rate for Payer: Zelis Auto |
$1,015.20
|
| Rate for Payer: Zelis Worker's Compensation |
$692.87
|
|
|
LAPS SUPRACRV HYSTERECT >250 G RMVL TUBE
|
Facility
|
OP
|
$2,785.00
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
6158544
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$760.30 |
| 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 |
$1,671.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,843.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,671.00
|
| Rate for Payer: Cash Price |
$1,671.00
|
| Rate for Payer: Cigna Commercial |
$2,367.25
|
| Rate for Payer: First Health Commercial |
$2,506.50
|
| Rate for Payer: First Health Workers Compensation |
$1,075.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,506.50
|
| Rate for Payer: GEHA Commercial |
$2,228.00
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,506.50
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,962.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,534.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,949.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,506.50
|
| 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 |
$2,645.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,088.75
|
| 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 |
$2,590.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,114.00
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$760.30
|
|
|
LAPS SUPRACRV HYSTERECT >250 G RMVL TUBE
|
Facility
|
IP
|
$2,785.00
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
6158544
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$760.30 |
| Max. Negotiated Rate |
$2,645.75 |
| Rate for Payer: Cash Price |
$1,671.00
|
| Rate for Payer: Cigna Commercial |
$2,367.25
|
| Rate for Payer: First Health Commercial |
$2,506.50
|
| Rate for Payer: First Health Workers Compensation |
$1,075.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,506.50
|
| Rate for Payer: GEHA Commercial |
$1,949.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,506.50
|
| Rate for Payer: Multiplan All |
$2,534.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,949.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,506.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,645.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,088.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,590.05
|
| Rate for Payer: Zelis Auto |
$1,114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$760.30
|
|
|
LAPS SURG PRST8ECT SMPL STOT ROBOTIC ASS
|
Facility
|
OP
|
$3,015.03
|
|
|
Service Code
|
CPT 55867
|
| Hospital Charge Code |
6155867
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$823.10 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13,630.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,809.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13,630.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10,798.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,809.02
|
| Rate for Payer: Cash Price |
$1,809.02
|
| Rate for Payer: Cigna Commercial |
$2,562.78
|
| Rate for Payer: First Health Commercial |
$2,713.53
|
| Rate for Payer: First Health Workers Compensation |
$1,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,713.53
|
| Rate for Payer: GEHA Commercial |
$2,412.02
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,713.53
|
| 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 |
$11,018.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,743.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,110.52
|
| Rate for Payer: One Health Plan PPO/POS |
$2,713.53
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12,722.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11,018.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,864.28
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,261.27
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11,018.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,803.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,206.01
|
| 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 |
$823.10
|
|
|
LAPS SURG PRST8ECT SMPL STOT ROBOTIC ASS
|
Facility
|
IP
|
$3,015.03
|
|
|
Service Code
|
CPT 55867
|
| Hospital Charge Code |
6155867
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$823.10 |
| Max. Negotiated Rate |
$2,864.28 |
| Rate for Payer: Cash Price |
$1,809.02
|
| Rate for Payer: Cigna Commercial |
$2,562.78
|
| Rate for Payer: First Health Commercial |
$2,713.53
|
| Rate for Payer: First Health Workers Compensation |
$1,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,713.53
|
| Rate for Payer: GEHA Commercial |
$2,110.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,713.53
|
| Rate for Payer: Multiplan All |
$2,743.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,110.52
|
| Rate for Payer: One Health Plan PPO/POS |
$2,713.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,864.28
|
| Rate for Payer: Three Rivers Provider Network All |
$2,261.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,803.98
|
| Rate for Payer: Zelis Auto |
$1,206.01
|
| Rate for Payer: Zelis Worker's Compensation |
$823.10
|
|
|
LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUB
|
Facility
|
OP
|
$2,833.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
6158571
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$773.41 |
| 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 |
$1,699.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Cigna Commercial |
$2,408.05
|
| Rate for Payer: First Health Commercial |
$2,549.70
|
| Rate for Payer: First Health Workers Compensation |
$1,093.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,549.70
|
| Rate for Payer: GEHA Commercial |
$2,266.40
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,549.70
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$2,578.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,983.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,549.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,691.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,124.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,634.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$1,133.20
|
| 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 |
$773.41
|
|
|
LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUB
|
Facility
|
IP
|
$2,833.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
6158571
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$773.41 |
| Max. Negotiated Rate |
$2,691.35 |
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Cigna Commercial |
$2,408.05
|
| Rate for Payer: First Health Commercial |
$2,549.70
|
| Rate for Payer: First Health Workers Compensation |
$1,093.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,549.70
|
| Rate for Payer: GEHA Commercial |
$1,983.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,549.70
|
| Rate for Payer: Multiplan All |
$2,578.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,983.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,549.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,691.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,124.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,634.69
|
| Rate for Payer: Zelis Auto |
$1,133.20
|
| Rate for Payer: Zelis Worker's Compensation |
$773.41
|
|
