|
LAPS TOT HYST RESJ MAL
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 58575
|
| Hospital Charge Code |
6169676
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$617.50 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$642.20
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,482.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$2,173.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$617.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,235.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
LAPS TOT HYST RESJ MAL
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 58575
|
| Hospital Charge Code |
6169676
|
|
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 TX ECTOPIC PREG W/SALPING&/OOPHOREC
|
Facility
|
OP
|
$2,411.00
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
23500062
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$658.20 |
| Max. Negotiated Rate |
$11,306.76 |
| 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 |
$1,446.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,751.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,653.38
|
| Rate for Payer: Cash Price |
$1,446.60
|
| Rate for Payer: Cash Price |
$1,446.60
|
| Rate for Payer: Cigna Commercial |
$2,049.35
|
| Rate for Payer: First Health Commercial |
$2,169.90
|
| Rate for Payer: First Health Workers Compensation |
$930.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,169.90
|
| Rate for Payer: GEHA Commercial |
$1,928.80
|
| Rate for Payer: GEHA Medicare |
$5,653.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,169.90
|
| Rate for Payer: Humana ChoiceCare |
$6,218.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,653.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,497.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,653.38
|
| Rate for Payer: Multiplan All |
$2,194.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,610.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,687.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,169.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,420.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,828.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,653.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,290.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,306.76
|
| Rate for Payer: Three Rivers Provider Network All |
$1,808.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,540.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,653.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,242.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,653.38
|
| Rate for Payer: Zelis Auto |
$964.40
|
| Rate for Payer: Zelis Medicare |
$4,805.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,784.06
|
| Rate for Payer: Zelis Worker's Compensation |
$658.20
|
|
|
LAPS TX ECTOPIC PREG W/SALPING&/OOPHOREC
|
Facility
|
OP
|
$14,457.00
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
6115861
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.82 |
| Max. Negotiated Rate |
$13,734.15 |
| 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 |
$8,674.20
|
| 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 |
$5,653.38
|
| Rate for Payer: Cash Price |
$8,674.20
|
| Rate for Payer: Cash Price |
$8,674.20
|
| Rate for Payer: Cigna Commercial |
$12,288.45
|
| Rate for Payer: First Health Commercial |
$13,011.30
|
| Rate for Payer: First Health Workers Compensation |
$7,275.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,011.30
|
| Rate for Payer: GEHA Commercial |
$11,565.60
|
| Rate for Payer: GEHA Medicare |
$5,653.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,011.30
|
| Rate for Payer: Humana ChoiceCare |
$6,218.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,653.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,497.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,653.38
|
| Rate for Payer: Multiplan All |
$13,155.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,610.75
|
| Rate for Payer: OMNI Networks Commercial |
$10,119.90
|
| Rate for Payer: One Health Plan PPO/POS |
$13,011.30
|
| 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 |
$5,653.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,734.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,306.76
|
| Rate for Payer: Three Rivers Provider Network All |
$10,842.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,540.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,653.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,445.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,653.38
|
| Rate for Payer: Zelis Auto |
$5,782.80
|
| Rate for Payer: Zelis Medicare |
$4,805.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,784.06
|
| Rate for Payer: Zelis Worker's Compensation |
$5,144.58
|
|
|
LAPS TX ECTOPIC PREG W/SALPING&/OOPHOREC
|
Facility
|
IP
|
$14,457.00
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
6115861
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,946.76 |
| Max. Negotiated Rate |
$13,734.15 |
| Rate for Payer: Cash Price |
$8,674.20
|
| Rate for Payer: Cigna Commercial |
$12,288.45
|
| Rate for Payer: First Health Commercial |
$13,011.30
|
| Rate for Payer: First Health Workers Compensation |
$5,581.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,011.30
|
| Rate for Payer: GEHA Commercial |
$10,119.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,011.30
|
| Rate for Payer: Multiplan All |
$13,155.87
|
| Rate for Payer: OMNI Networks Commercial |
$10,119.90
|
| Rate for Payer: One Health Plan PPO/POS |
$13,011.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,734.15
|
| Rate for Payer: Three Rivers Provider Network All |
$10,842.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,445.01
|
| Rate for Payer: Zelis Auto |
$5,782.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3,946.76
|
|
|
LAPS TX ECTOPIC PREG W/SALPING&/OOPHOREC
|
Facility
|
IP
|
$2,411.00
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
23500062
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$658.20 |
| Max. Negotiated Rate |
$2,290.45 |
| Rate for Payer: Cash Price |
$1,446.60
|
| Rate for Payer: Cigna Commercial |
$2,049.35
|
| Rate for Payer: First Health Commercial |
$2,169.90
|
| Rate for Payer: First Health Workers Compensation |
$930.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,169.90
|
| Rate for Payer: GEHA Commercial |
$1,687.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,169.90
|
| Rate for Payer: Multiplan All |
$2,194.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,687.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,169.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,290.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,808.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,242.23
|
| Rate for Payer: Zelis Auto |
$964.40
|
| Rate for Payer: Zelis Worker's Compensation |
$658.20
|
|
|
LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
CPT 58550
|
| Hospital Charge Code |
6158550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$740.92 |
| Max. Negotiated Rate |
$11,306.76 |
| 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 |
$1,628.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,843.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,653.38
|
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cigna Commercial |
$2,306.90
|
| Rate for Payer: First Health Commercial |
$2,442.60
|
| Rate for Payer: First Health Workers Compensation |
$1,047.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,442.60
|
| Rate for Payer: GEHA Commercial |
$2,171.20
|
| Rate for Payer: GEHA Medicare |
$5,653.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,442.60
|
| Rate for Payer: Humana ChoiceCare |
$6,218.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,653.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,497.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,962.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,653.38
|
| Rate for Payer: Multiplan All |
$2,469.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,610.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,899.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,442.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,884.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,962.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,653.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,578.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,306.76
|
| Rate for Payer: Three Rivers Provider Network All |
$2,035.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,540.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,962.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,653.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,524.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,653.38
|
| Rate for Payer: Zelis Auto |
$1,085.60
|
| Rate for Payer: Zelis Medicare |
$4,805.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,784.06
|
| Rate for Payer: Zelis Worker's Compensation |
$740.92
|
|
|
LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
CPT 58550
|
| Hospital Charge Code |
6158550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$740.92 |
| Max. Negotiated Rate |
$2,578.30 |
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cigna Commercial |
$2,306.90
|
| Rate for Payer: First Health Commercial |
$2,442.60
|
| Rate for Payer: First Health Workers Compensation |
$1,047.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,442.60
|
| Rate for Payer: GEHA Commercial |
$1,899.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,442.60
|
| Rate for Payer: Multiplan All |
$2,469.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,899.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,442.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,578.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,035.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,524.02
|
| Rate for Payer: Zelis Auto |
$1,085.60
|
| Rate for Payer: Zelis Worker's Compensation |
$740.92
|
|
|
LAPS W/VAG HYSTERCT 250 GM/&RMVL TUBE&/O
|
Facility
|
OP
|
$3,064.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
6158552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$836.47 |
| Max. Negotiated Rate |
$20,176.52 |
| 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 |
$1,838.40
|
| 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 |
$10,088.26
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cigna Commercial |
$2,604.40
|
| Rate for Payer: First Health Commercial |
$2,757.60
|
| Rate for Payer: First Health Workers Compensation |
$1,183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,757.60
|
| Rate for Payer: GEHA Commercial |
$2,451.20
|
| Rate for Payer: GEHA Medicare |
$10,088.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,757.60
|
| Rate for Payer: Humana ChoiceCare |
$11,097.09
|
| Rate for Payer: Humana Medicare Advantage |
$10,088.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,948.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,828.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,088.26
|
| Rate for Payer: Multiplan All |
$2,788.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17,150.04
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,757.60
|
| 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 |
$10,088.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,910.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20,176.52
|
| Rate for Payer: Three Rivers Provider Network All |
$2,298.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,886.49
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,828.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,088.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,849.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10,088.26
|
| Rate for Payer: Zelis Auto |
$1,225.60
|
| Rate for Payer: Zelis Medicare |
$8,575.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12,105.91
|
| Rate for Payer: Zelis Worker's Compensation |
$836.47
|
|
|
LAPS W/VAG HYSTERCT 250 GM/&RMVL TUBE&/O
|
Facility
|
IP
|
$3,064.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
6158552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$836.47 |
| Max. Negotiated Rate |
$2,910.80 |
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cigna Commercial |
$2,604.40
|
| Rate for Payer: First Health Commercial |
$2,757.60
|
| Rate for Payer: First Health Workers Compensation |
$1,183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,757.60
|
| Rate for Payer: GEHA Commercial |
$2,144.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,757.60
|
| Rate for Payer: Multiplan All |
$2,788.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,757.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,910.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,298.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,849.52
|
| Rate for Payer: Zelis Auto |
$1,225.60
|
| Rate for Payer: Zelis Worker's Compensation |
$836.47
|
|
|
LAP VENT/ABD HERNIA REPAIR
|
Facility
|
OP
|
$1,560.00
|
|
|
Service Code
|
CPT 49652
|
| Hospital Charge Code |
6149652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,326.00
|
| Rate for Payer: First Health Commercial |
$1,404.00
|
| Rate for Payer: First Health Workers Compensation |
$602.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.00
|
| Rate for Payer: GEHA Commercial |
$1,248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.00
|
| Rate for Payer: Humana ChoiceCare |
$405.60
|
| Rate for Payer: Multiplan All |
$1,419.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$936.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,372.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$390.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,450.80
|
| Rate for Payer: Zelis Auto |
$624.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$780.00
|
| Rate for Payer: Zelis Worker's Compensation |
$425.88
|
|
|
LAP VENT/ABD HERNIA REPAIR
|
Facility
|
IP
|
$1,560.00
|
|
|
Service Code
|
CPT 49652
|
| Hospital Charge Code |
6149652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.88 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,326.00
|
| Rate for Payer: First Health Commercial |
$1,404.00
|
| Rate for Payer: First Health Workers Compensation |
$602.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.00
|
| Rate for Payer: GEHA Commercial |
$1,092.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.00
|
| Rate for Payer: Multiplan All |
$1,419.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,450.80
|
| Rate for Payer: Zelis Auto |
$624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$425.88
|
|
|
LAP VENT/ABD HERN PROC COMP
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 49653
|
| Hospital Charge Code |
6149653
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$486.75 |
| Max. Negotiated Rate |
$1,849.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cigna Commercial |
$1,654.95
|
| Rate for Payer: First Health Commercial |
$1,752.30
|
| Rate for Payer: First Health Workers Compensation |
$751.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,752.30
|
| Rate for Payer: GEHA Commercial |
$1,557.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,752.30
|
| Rate for Payer: Humana ChoiceCare |
$506.22
|
| Rate for Payer: Multiplan All |
$1,771.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,168.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,362.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,752.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,849.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,460.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,713.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$486.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,810.71
|
| Rate for Payer: Zelis Auto |
$778.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$973.50
|
| Rate for Payer: Zelis Worker's Compensation |
$531.53
|
|
|
LAP VENT/ABD HERN PROC COMP
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 49653
|
| Hospital Charge Code |
6149653
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$531.53 |
| Max. Negotiated Rate |
$1,849.65 |
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cigna Commercial |
$1,654.95
|
| Rate for Payer: First Health Commercial |
$1,752.30
|
| Rate for Payer: First Health Workers Compensation |
$751.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,752.30
|
| Rate for Payer: GEHA Commercial |
$1,362.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,752.30
|
| Rate for Payer: Multiplan All |
$1,771.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,362.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,752.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,849.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,460.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,810.71
|
| Rate for Payer: Zelis Auto |
$778.80
|
| Rate for Payer: Zelis Worker's Compensation |
$531.53
|
|
|
LAP W/OMENTOPEXY ADD-ON
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 49326
|
| Hospital Charge Code |
6149326
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: First Health Workers Compensation |
$233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Worker's Compensation |
$165.16
|
|
|
LAP W/OMENTOPEXY ADD-ON
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 49326
|
| Hospital Charge Code |
6149326
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.30 |
| Max. Negotiated Rate |
$3,847.61 |
| 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 |
$363.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,048.07
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: First Health Workers Compensation |
$233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$484.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$157.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,110.15
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$363.00
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,591.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,110.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$532.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,110.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.50
|
| Rate for Payer: Zelis Worker's Compensation |
$165.16
|
|
|
LARGSC W/INJX AUGMENTATION
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
CPT 31574
|
| Hospital Charge Code |
6191075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.44 |
| Max. Negotiated Rate |
$1,835.40 |
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cigna Commercial |
$1,642.20
|
| Rate for Payer: First Health Commercial |
$1,738.80
|
| Rate for Payer: First Health Workers Compensation |
$745.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,738.80
|
| Rate for Payer: GEHA Commercial |
$1,352.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,738.80
|
| Rate for Payer: Multiplan All |
$1,758.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,352.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,738.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,835.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,796.76
|
| Rate for Payer: Zelis Auto |
$772.80
|
| Rate for Payer: Zelis Worker's Compensation |
$527.44
|
|
|
LARGSC W/INJX AUGMENTATION
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
CPT 31574
|
| Hospital Charge Code |
6191075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.44 |
| Max. Negotiated Rate |
$3,341.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,903.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,159.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,903.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,508.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,670.98
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cigna Commercial |
$1,642.20
|
| Rate for Payer: First Health Commercial |
$1,738.80
|
| Rate for Payer: First Health Workers Compensation |
$745.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,738.80
|
| Rate for Payer: GEHA Commercial |
$1,545.60
|
| Rate for Payer: GEHA Medicare |
$1,670.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,838.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,670.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,807.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,538.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,670.98
|
| Rate for Payer: Multiplan All |
$1,758.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,840.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,352.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,738.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,776.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,538.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,670.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,835.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,341.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,637.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,538.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,670.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,796.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,670.98
|
| Rate for Payer: Zelis Auto |
$772.80
|
| Rate for Payer: Zelis Medicare |
$1,420.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,005.18
|
| Rate for Payer: Zelis Worker's Compensation |
$527.44
|
|
|
LARGSC W/LASER DSTR LES
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
CPT 31572
|
| Hospital Charge Code |
6191074
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,010.10 |
| Max. Negotiated Rate |
$3,515.00 |
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: First Health Commercial |
$3,330.00
|
| Rate for Payer: First Health Workers Compensation |
$1,428.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,330.00
|
| Rate for Payer: GEHA Commercial |
$2,590.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,330.00
|
| Rate for Payer: Multiplan All |
$3,367.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,590.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,330.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,515.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,775.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,441.00
|
| Rate for Payer: Zelis Auto |
$1,480.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,010.10
|
|
|
LARGSC W/LASER DSTR LES
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
CPT 31572
|
| Hospital Charge Code |
6191074
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,010.10 |
| Max. Negotiated Rate |
$7,145.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,645.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,220.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,645.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,887.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,572.58
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: First Health Commercial |
$3,330.00
|
| Rate for Payer: First Health Workers Compensation |
$1,428.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,330.00
|
| Rate for Payer: GEHA Commercial |
$2,960.00
|
| Rate for Payer: GEHA Medicare |
$3,572.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,330.00
|
| Rate for Payer: Humana ChoiceCare |
$3,929.84
|
| Rate for Payer: Humana Medicare Advantage |
$3,572.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,001.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,946.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,572.58
|
| Rate for Payer: Multiplan All |
$3,367.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,073.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,590.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,330.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,402.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,946.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,572.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,515.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,145.16
|
| Rate for Payer: Three Rivers Provider Network All |
$2,775.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,501.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,946.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,572.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,441.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,572.58
|
| Rate for Payer: Zelis Auto |
$1,480.00
|
| Rate for Payer: Zelis Medicare |
$3,036.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,287.10
|
| Rate for Payer: Zelis Worker's Compensation |
$1,010.10
|
|
|
LARGSC W/THER INJECTION
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
CPT 31573
|
| Hospital Charge Code |
6191076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.44 |
| Max. Negotiated Rate |
$3,341.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,903.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,159.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,903.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,508.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,670.98
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cigna Commercial |
$1,642.20
|
| Rate for Payer: First Health Commercial |
$1,738.80
|
| Rate for Payer: First Health Workers Compensation |
$745.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,738.80
|
| Rate for Payer: GEHA Commercial |
$1,545.60
|
| Rate for Payer: GEHA Medicare |
$1,670.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,838.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,670.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,807.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,538.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,670.98
|
| Rate for Payer: Multiplan All |
$1,758.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,840.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,352.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,738.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,776.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,538.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,670.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,835.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,341.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,637.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,538.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,670.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,796.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,670.98
|
| Rate for Payer: Zelis Auto |
$772.80
|
| Rate for Payer: Zelis Medicare |
$1,420.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,005.18
|
| Rate for Payer: Zelis Worker's Compensation |
$527.44
|
|
|
LARGSC W/THER INJECTION
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
CPT 31573
|
| Hospital Charge Code |
6191076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.44 |
| Max. Negotiated Rate |
$1,835.40 |
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cigna Commercial |
$1,642.20
|
| Rate for Payer: First Health Commercial |
$1,738.80
|
| Rate for Payer: First Health Workers Compensation |
$745.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,738.80
|
| Rate for Payer: GEHA Commercial |
$1,352.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,738.80
|
| Rate for Payer: Multiplan All |
$1,758.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,352.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,738.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,835.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,796.76
|
| Rate for Payer: Zelis Auto |
$772.80
|
| Rate for Payer: Zelis Worker's Compensation |
$527.44
|
|
|
LARYNGOPLASTY MEDIALIZATION
|
Facility
|
IP
|
$6,287.00
|
|
|
Service Code
|
CPT 31591
|
| Hospital Charge Code |
6191081
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$5,972.65 |
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$4,400.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGOPLASTY MEDIALIZATION
|
Facility
|
OP
|
$6,287.00
|
|
|
Service Code
|
CPT 31591
|
| Hospital Charge Code |
6191081
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$11,464.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,772.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,906.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,732.16
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$5,029.60
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,006.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,780.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,006.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,006.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGOSCOPE W/VC INJ
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 31570
|
| Hospital Charge Code |
6131570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: First Health Commercial |
$540.00
|
| Rate for Payer: First Health Workers Compensation |
$231.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.00
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.00
|
| Rate for Payer: Multiplan All |
$546.00
|
| Rate for Payer: OMNI Networks Commercial |
$420.00
|
| Rate for Payer: One Health Plan PPO/POS |
$540.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.00
|
| Rate for Payer: Three Rivers Provider Network All |
$450.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.00
|
| Rate for Payer: Zelis Auto |
$240.00
|
| Rate for Payer: Zelis Worker's Compensation |
$163.80
|
|
