|
LIDOCAINE DRIP 2GM/500ML D5W PREMIX
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
3300514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
LIDOCAINE HCL 2% MPF 5 ML vial
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3301972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
LIDOCAINE HCL 2% MPF 5 ML vial
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3301972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 63323028955
|
| Hospital Charge Code |
3300529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
NDC 63323028955
|
| Hospital Charge Code |
3300529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,730.88 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
LIGATE/DIVIDE/EXCISE VEIN
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
6137785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.64 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: First Health Workers Compensation |
$266.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$483.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
| Rate for Payer: Zelis Worker's Compensation |
$188.64
|
|
|
LIGATE/DIVIDE/EXCISE VEIN
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
6137785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.64 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,128.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: First Health Workers Compensation |
$266.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$552.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,171.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,507.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,171.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,171.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$276.40
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$188.64
|
|
|
LIGATE ESOPHAGUS VEINS
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 43400
|
| Hospital Charge Code |
6143400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$843.30 |
| Max. Negotiated Rate |
$2,934.55 |
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$2,625.65
|
| Rate for Payer: First Health Commercial |
$2,780.10
|
| Rate for Payer: First Health Workers Compensation |
$1,192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,780.10
|
| Rate for Payer: GEHA Commercial |
$2,162.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,780.10
|
| Rate for Payer: Multiplan All |
$2,810.99
|
| Rate for Payer: OMNI Networks Commercial |
$2,162.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,780.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,934.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,316.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,872.77
|
| Rate for Payer: Zelis Auto |
$1,235.60
|
| Rate for Payer: Zelis Worker's Compensation |
$843.30
|
|
|
LIGATE ESOPHAGUS VEINS
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 43400
|
| Hospital Charge Code |
6143400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$772.25 |
| Max. Negotiated Rate |
$2,934.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,853.40
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$2,625.65
|
| Rate for Payer: First Health Commercial |
$2,780.10
|
| Rate for Payer: First Health Workers Compensation |
$1,192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,780.10
|
| Rate for Payer: GEHA Commercial |
$2,471.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,780.10
|
| Rate for Payer: Humana ChoiceCare |
$803.14
|
| Rate for Payer: Multiplan All |
$2,810.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,853.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,162.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,780.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,934.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,316.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,718.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$772.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,872.77
|
| Rate for Payer: Zelis Auto |
$1,235.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,544.50
|
| Rate for Payer: Zelis Worker's Compensation |
$843.30
|
|
|
LIGATE LEG VEINS OPEN
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
CPT 37761
|
| Hospital Charge Code |
6137761
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$1,115.30 |
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cigna Commercial |
$997.90
|
| Rate for Payer: First Health Commercial |
$1,056.60
|
| Rate for Payer: First Health Workers Compensation |
$453.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,056.60
|
| Rate for Payer: GEHA Commercial |
$821.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,056.60
|
| Rate for Payer: Multiplan All |
$1,068.34
|
| Rate for Payer: OMNI Networks Commercial |
$821.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,056.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,115.30
|
| Rate for Payer: Three Rivers Provider Network All |
$880.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,091.82
|
| Rate for Payer: Zelis Auto |
$469.60
|
| Rate for Payer: Zelis Worker's Compensation |
$320.50
|
|
|
LIGATE LEG VEINS OPEN
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
CPT 37761
|
| Hospital Charge Code |
6137761
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,128.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cigna Commercial |
$997.90
|
| Rate for Payer: First Health Commercial |
$1,056.60
|
| Rate for Payer: First Health Workers Compensation |
$453.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,056.60
|
| Rate for Payer: GEHA Commercial |
$939.20
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,056.60
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,171.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,068.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$821.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,056.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,507.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,171.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,115.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$880.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,171.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,091.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$469.60
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$320.50
|
|
|
LIGATE/STAPLE ESOPHAGUS
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 43405
|
| Hospital Charge Code |
6143405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$843.30 |
| Max. Negotiated Rate |
$2,934.55 |
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$2,625.65
|
| Rate for Payer: First Health Commercial |
$2,780.10
|
| Rate for Payer: First Health Workers Compensation |
$1,192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,780.10
|
| Rate for Payer: GEHA Commercial |
$2,162.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,780.10
|
| Rate for Payer: Multiplan All |
$2,810.99
|
| Rate for Payer: OMNI Networks Commercial |
$2,162.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,780.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,934.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,316.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,872.77
|
| Rate for Payer: Zelis Auto |
$1,235.60
|
| Rate for Payer: Zelis Worker's Compensation |
$843.30
|
|
|
LIGATE/STAPLE ESOPHAGUS
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 43405
|
| Hospital Charge Code |
6143405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$772.25 |
| Max. Negotiated Rate |
$2,934.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,853.40
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$2,625.65
|
| Rate for Payer: First Health Commercial |
$2,780.10
|
| Rate for Payer: First Health Workers Compensation |
$1,192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,780.10
|
| Rate for Payer: GEHA Commercial |
$2,471.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,780.10
|
| Rate for Payer: Humana ChoiceCare |
$803.14
|
| Rate for Payer: Multiplan All |
$2,810.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,853.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,162.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,780.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,934.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,316.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,718.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$772.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,872.77
|
| Rate for Payer: Zelis Auto |
$1,235.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,544.50
|
| Rate for Payer: Zelis Worker's Compensation |
$843.30
|
|
|
LIGATE/STRIP LONG LEG VEIN
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 37722
|
| Hospital Charge Code |
6137722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$279.82 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
LIGATE/STRIP LONG LEG VEIN
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 37722
|
| Hospital Charge Code |
6137722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$279.82 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,552.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,552.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,606.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,680.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,249.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,680.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,680.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
LIGATION, LEG VEINS, OPEN
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT 37760
|
| Hospital Charge Code |
6137760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.81 |
| Max. Negotiated Rate |
$1,252.10 |
| Rate for Payer: Cash Price |
$790.80
|
| Rate for Payer: Cigna Commercial |
$1,120.30
|
| Rate for Payer: First Health Commercial |
$1,186.20
|
| Rate for Payer: First Health Workers Compensation |
$508.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,186.20
|
| Rate for Payer: GEHA Commercial |
$922.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,186.20
|
| Rate for Payer: Multiplan All |
$1,199.38
|
| Rate for Payer: OMNI Networks Commercial |
$922.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,186.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,252.10
|
| Rate for Payer: Three Rivers Provider Network All |
$988.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,225.74
|
| Rate for Payer: Zelis Auto |
$527.20
|
| Rate for Payer: Zelis Worker's Compensation |
$359.81
|
|
|
LIGATION, LEG VEINS, OPEN
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT 37760
|
| Hospital Charge Code |
6137760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.81 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$790.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,128.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$790.80
|
| Rate for Payer: Cash Price |
$790.80
|
| Rate for Payer: Cigna Commercial |
$1,120.30
|
| Rate for Payer: First Health Commercial |
$1,186.20
|
| Rate for Payer: First Health Workers Compensation |
$508.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,186.20
|
| Rate for Payer: GEHA Commercial |
$1,054.40
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,186.20
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,171.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,199.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$922.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,186.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,507.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,171.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,252.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$988.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,171.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,225.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$527.20
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$359.81
|
|
|
LIGATION NASAL SINUS ARTERY
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 30915
|
| Hospital Charge Code |
6130915
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.05 |
| Max. Negotiated Rate |
$1,106.75 |
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$990.25
|
| Rate for Payer: First Health Commercial |
$1,048.50
|
| Rate for Payer: First Health Workers Compensation |
$449.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,048.50
|
| Rate for Payer: GEHA Commercial |
$815.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,048.50
|
| Rate for Payer: Multiplan All |
$1,060.15
|
| Rate for Payer: OMNI Networks Commercial |
$815.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,048.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,106.75
|
| Rate for Payer: Three Rivers Provider Network All |
$873.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,083.45
|
| Rate for Payer: Zelis Auto |
$466.00
|
| Rate for Payer: Zelis Worker's Compensation |
$318.05
|
|
|
LIGATION NASAL SINUS ARTERY
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 30915
|
| Hospital Charge Code |
6130915
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.05 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$699.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,128.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$990.25
|
| Rate for Payer: First Health Commercial |
$1,048.50
|
| Rate for Payer: First Health Workers Compensation |
$449.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,048.50
|
| Rate for Payer: GEHA Commercial |
$932.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,048.50
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,171.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,060.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$815.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,048.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,507.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,171.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,106.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$873.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,171.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,083.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$466.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$318.05
|
|
|
LIGATION OF EXTREMITY ARTERY
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT 37618
|
| Hospital Charge Code |
6137618
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$961.40 |
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$708.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
LIGATION OF EXTREMITY ARTERY
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 37618
|
| Hospital Charge Code |
6137618
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$961.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$809.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$263.12
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$607.20
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$506.00
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
LIGATION OF INF VENA CAVA
|
Facility
|
IP
|
$3,497.00
|
|
|
Service Code
|
CPT 37619
|
| Hospital Charge Code |
6137619
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$954.68 |
| Max. Negotiated Rate |
$3,322.15 |
| Rate for Payer: Cash Price |
$2,098.20
|
| Rate for Payer: Cigna Commercial |
$2,972.45
|
| Rate for Payer: First Health Commercial |
$3,147.30
|
| Rate for Payer: First Health Workers Compensation |
$1,350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,147.30
|
| Rate for Payer: GEHA Commercial |
$2,447.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,147.30
|
| Rate for Payer: Multiplan All |
$3,182.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,447.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,147.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,322.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,622.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,252.21
|
| Rate for Payer: Zelis Auto |
$1,398.80
|
| Rate for Payer: Zelis Worker's Compensation |
$954.68
|
|
|
LIGATION OF INF VENA CAVA
|
Facility
|
OP
|
$3,497.00
|
|
|
Service Code
|
CPT 37619
|
| Hospital Charge Code |
6137619
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$954.68 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,467.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,098.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,467.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,538.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$2,098.20
|
| Rate for Payer: Cash Price |
$2,098.20
|
| Rate for Payer: Cigna Commercial |
$2,972.45
|
| Rate for Payer: First Health Commercial |
$3,147.30
|
| Rate for Payer: First Health Workers Compensation |
$1,350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,147.30
|
| Rate for Payer: GEHA Commercial |
$2,797.60
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,147.30
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,610.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$3,182.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,447.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,147.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,169.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,610.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,322.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$2,622.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,610.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,252.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$1,398.80
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$954.68
|
|
|
LIGATION OF SALIVARY DUCT
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 42665
|
| Hospital Charge Code |
6142665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
