|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 25151
|
| Hospital Charge Code |
6125151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.87 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$1,011.50
|
| Rate for Payer: First Health Commercial |
$1,071.00
|
| Rate for Payer: First Health Workers Compensation |
$459.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,071.00
|
| Rate for Payer: GEHA Commercial |
$952.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,071.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,082.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$833.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,071.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,130.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$892.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,106.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$476.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$324.87
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 25230
|
| Hospital Charge Code |
6125230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$613.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 25230
|
| Hospital Charge Code |
6125230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
IP
|
$3,464.00
|
|
|
Service Code
|
CPT 45116
|
| Hospital Charge Code |
6145116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$945.67 |
| Max. Negotiated Rate |
$3,290.80 |
| Rate for Payer: Cash Price |
$2,078.40
|
| Rate for Payer: Cigna Commercial |
$2,944.40
|
| Rate for Payer: First Health Commercial |
$3,117.60
|
| Rate for Payer: First Health Workers Compensation |
$1,337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,117.60
|
| Rate for Payer: GEHA Commercial |
$2,424.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,117.60
|
| Rate for Payer: Multiplan All |
$3,152.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,424.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,117.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,290.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,598.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,221.52
|
| Rate for Payer: Zelis Auto |
$1,385.60
|
| Rate for Payer: Zelis Worker's Compensation |
$945.67
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
OP
|
$2,275.00
|
|
|
Service Code
|
CPT 45111
|
| Hospital Charge Code |
6145111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$2,161.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,365.00
|
| Rate for Payer: Cash Price |
$1,365.00
|
| Rate for Payer: Cigna Commercial |
$1,933.75
|
| Rate for Payer: First Health Commercial |
$2,047.50
|
| Rate for Payer: First Health Workers Compensation |
$878.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,047.50
|
| Rate for Payer: GEHA Commercial |
$1,820.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,047.50
|
| Rate for Payer: Humana ChoiceCare |
$591.50
|
| Rate for Payer: Multiplan All |
$2,070.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,365.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,592.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,047.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,161.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,706.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,002.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$568.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,115.75
|
| Rate for Payer: Zelis Auto |
$910.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,137.50
|
| Rate for Payer: Zelis Worker's Compensation |
$621.08
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
IP
|
$2,275.00
|
|
|
Service Code
|
CPT 45111
|
| Hospital Charge Code |
6145111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$621.08 |
| Max. Negotiated Rate |
$2,161.25 |
| Rate for Payer: Cash Price |
$1,365.00
|
| Rate for Payer: Cigna Commercial |
$1,933.75
|
| Rate for Payer: First Health Commercial |
$2,047.50
|
| Rate for Payer: First Health Workers Compensation |
$878.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,047.50
|
| Rate for Payer: GEHA Commercial |
$1,592.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,047.50
|
| Rate for Payer: Multiplan All |
$2,070.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,592.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,047.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,161.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,706.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,115.75
|
| Rate for Payer: Zelis Auto |
$910.00
|
| Rate for Payer: Zelis Worker's Compensation |
$621.08
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
IP
|
$3,835.00
|
|
|
Service Code
|
CPT 45114
|
| Hospital Charge Code |
6145114
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,046.95 |
| Max. Negotiated Rate |
$3,643.25 |
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cigna Commercial |
$3,259.75
|
| Rate for Payer: First Health Commercial |
$3,451.50
|
| Rate for Payer: First Health Workers Compensation |
$1,480.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,451.50
|
| Rate for Payer: GEHA Commercial |
$2,684.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,451.50
|
| Rate for Payer: Multiplan All |
$3,489.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,684.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,451.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,643.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,876.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,566.55
|
| Rate for Payer: Zelis Auto |
$1,534.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,046.95
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
OP
|
$3,835.00
|
|
|
Service Code
|
CPT 45114
|
| Hospital Charge Code |
6145114
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$958.75 |
| Max. Negotiated Rate |
$3,643.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,301.00
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cigna Commercial |
$3,259.75
|
| Rate for Payer: First Health Commercial |
$3,451.50
|
| Rate for Payer: First Health Workers Compensation |
$1,480.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,451.50
|
| Rate for Payer: GEHA Commercial |
$3,068.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,451.50
|
| Rate for Payer: Humana ChoiceCare |
$997.10
|
| Rate for Payer: Multiplan All |
$3,489.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,301.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,684.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,451.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,643.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,876.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,374.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$958.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,566.55
|
| Rate for Payer: Zelis Auto |
$1,534.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,917.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,046.95
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
OP
|
$3,464.00
|
|
|
Service Code
|
CPT 45116
|
| Hospital Charge Code |
6145116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$866.00 |
| Max. Negotiated Rate |
$3,290.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,078.40
|
| Rate for Payer: Cash Price |
$2,078.40
|
| Rate for Payer: Cigna Commercial |
$2,944.40
|
| Rate for Payer: First Health Commercial |
$3,117.60
|
| Rate for Payer: First Health Workers Compensation |
$1,337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,117.60
|
| Rate for Payer: GEHA Commercial |
$2,771.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,117.60
|
| Rate for Payer: Humana ChoiceCare |
$900.64
|
| Rate for Payer: Multiplan All |
$3,152.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,078.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,424.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,117.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,290.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,598.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,048.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$866.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,221.52
|
| Rate for Payer: Zelis Auto |
$1,385.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,732.00
|
| Rate for Payer: Zelis Worker's Compensation |
$945.67
|
|
|
PARTIAL REMOVAL OF RIB
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
CPT 21610
|
| Hospital Charge Code |
6121610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$689.05 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,514.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna Commercial |
$2,145.40
|
| Rate for Payer: First Health Commercial |
$2,271.60
|
| Rate for Payer: First Health Workers Compensation |
$974.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,271.60
|
| Rate for Payer: GEHA Commercial |
$2,019.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,271.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,296.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,271.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,397.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,893.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,347.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$1,009.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$689.05
|
|
|
PARTIAL REMOVAL OF RIB
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 21600
|
| Hospital Charge Code |
6121600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.58 |
| Max. Negotiated Rate |
$1,087.75 |
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$973.25
|
| Rate for Payer: First Health Commercial |
$1,030.50
|
| Rate for Payer: First Health Workers Compensation |
$442.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,030.50
|
| Rate for Payer: GEHA Commercial |
$801.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,030.50
|
| Rate for Payer: Multiplan All |
$1,041.95
|
| Rate for Payer: OMNI Networks Commercial |
$801.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,030.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,087.75
|
| Rate for Payer: Three Rivers Provider Network All |
$858.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,064.85
|
| Rate for Payer: Zelis Auto |
$458.00
|
| Rate for Payer: Zelis Worker's Compensation |
$312.58
|
|
|
PARTIAL REMOVAL OF RIB
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 21600
|
| Hospital Charge Code |
6121600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.58 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$687.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$973.25
|
| Rate for Payer: First Health Commercial |
$1,030.50
|
| Rate for Payer: First Health Workers Compensation |
$442.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,030.50
|
| Rate for Payer: GEHA Commercial |
$916.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,030.50
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,041.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$801.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,030.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,087.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$858.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,064.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$458.00
|
| 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 |
$312.58
|
|
|
PARTIAL REMOVAL OF RIB
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
CPT 21610
|
| Hospital Charge Code |
6121610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$689.05 |
| Max. Negotiated Rate |
$2,397.80 |
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna Commercial |
$2,145.40
|
| Rate for Payer: First Health Commercial |
$2,271.60
|
| Rate for Payer: First Health Workers Compensation |
$974.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,271.60
|
| Rate for Payer: GEHA Commercial |
$1,766.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,271.60
|
| Rate for Payer: Multiplan All |
$2,296.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,271.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,397.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,893.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,347.32
|
| Rate for Payer: Zelis Auto |
$1,009.60
|
| Rate for Payer: Zelis Worker's Compensation |
$689.05
|
|
|
PARTIAL REMOVAL OF SCAPULA
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 23190
|
| Hospital Charge Code |
6123190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
PARTIAL REMOVAL OF SCAPULA
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 23190
|
| Hospital Charge Code |
6123190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$928.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
PARTIAL REMOVAL OF STERNUM
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 21620
|
| Hospital Charge Code |
6121620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$284.74 |
| Max. Negotiated Rate |
$990.85 |
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Cigna Commercial |
$886.55
|
| Rate for Payer: First Health Commercial |
$938.70
|
| Rate for Payer: First Health Workers Compensation |
$402.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$938.70
|
| Rate for Payer: GEHA Commercial |
$730.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$938.70
|
| Rate for Payer: Multiplan All |
$949.13
|
| Rate for Payer: OMNI Networks Commercial |
$730.10
|
| Rate for Payer: One Health Plan PPO/POS |
$938.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$990.85
|
| Rate for Payer: Three Rivers Provider Network All |
$782.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$969.99
|
| Rate for Payer: Zelis Auto |
$417.20
|
| Rate for Payer: Zelis Worker's Compensation |
$284.74
|
|
|
PARTIAL REMOVAL OF STERNUM
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 21620
|
| Hospital Charge Code |
6121620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.75 |
| Max. Negotiated Rate |
$990.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$625.80
|
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Cigna Commercial |
$886.55
|
| Rate for Payer: First Health Commercial |
$938.70
|
| Rate for Payer: First Health Workers Compensation |
$402.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$938.70
|
| Rate for Payer: GEHA Commercial |
$834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$938.70
|
| Rate for Payer: Humana ChoiceCare |
$271.18
|
| Rate for Payer: Multiplan All |
$949.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$625.80
|
| Rate for Payer: OMNI Networks Commercial |
$730.10
|
| Rate for Payer: One Health Plan PPO/POS |
$938.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$990.85
|
| Rate for Payer: Three Rivers Provider Network All |
$782.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$917.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$260.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$969.99
|
| Rate for Payer: Zelis Auto |
$417.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$521.50
|
| Rate for Payer: Zelis Worker's Compensation |
$284.74
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
6160220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.31 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cigna Commercial |
$1,249.50
|
| Rate for Payer: First Health Commercial |
$1,323.00
|
| Rate for Payer: First Health Workers Compensation |
$567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.00
|
| Rate for Payer: GEHA Commercial |
$1,176.00
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.00
|
| 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 |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,337.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,396.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,102.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,367.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$588.00
|
| 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 |
$401.31
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 60225
|
| Hospital Charge Code |
6160225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.62 |
| Max. Negotiated Rate |
$1,843.00 |
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cigna Commercial |
$1,649.00
|
| Rate for Payer: First Health Commercial |
$1,746.00
|
| Rate for Payer: First Health Workers Compensation |
$749.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,746.00
|
| Rate for Payer: GEHA Commercial |
$1,358.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,746.00
|
| Rate for Payer: Multiplan All |
$1,765.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,358.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,746.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,843.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,455.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,804.20
|
| Rate for Payer: Zelis Auto |
$776.00
|
| Rate for Payer: Zelis Worker's Compensation |
$529.62
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
6160220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.31 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cigna Commercial |
$1,249.50
|
| Rate for Payer: First Health Commercial |
$1,323.00
|
| Rate for Payer: First Health Workers Compensation |
$567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.00
|
| Rate for Payer: GEHA Commercial |
$1,029.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.00
|
| Rate for Payer: Multiplan All |
$1,337.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,396.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,102.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,367.10
|
| Rate for Payer: Zelis Auto |
$588.00
|
| Rate for Payer: Zelis Worker's Compensation |
$401.31
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT 60225
|
| Hospital Charge Code |
6160225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.62 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,164.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cigna Commercial |
$1,649.00
|
| Rate for Payer: First Health Commercial |
$1,746.00
|
| Rate for Payer: First Health Workers Compensation |
$749.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,746.00
|
| Rate for Payer: GEHA Commercial |
$1,552.00
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,746.00
|
| 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 |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,765.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,358.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,746.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,843.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,455.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,804.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$776.00
|
| 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 |
$529.62
|
|
|
PARTIAL REMOVAL OF TIBIA
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
6127640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$468.19 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 Community HMO |
$1,029.00
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,457.75
|
| Rate for Payer: First Health Commercial |
$1,543.50
|
| Rate for Payer: First Health Workers Compensation |
$662.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,543.50
|
| Rate for Payer: GEHA Commercial |
$1,372.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,543.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,560.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,200.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,543.50
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,629.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,286.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,594.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$686.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$468.19
|
|
|
PARTIAL REMOVAL OF TIBIA
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
6127640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$468.19 |
| Max. Negotiated Rate |
$1,629.25 |
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,457.75
|
| Rate for Payer: First Health Commercial |
$1,543.50
|
| Rate for Payer: First Health Workers Compensation |
$662.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,543.50
|
| Rate for Payer: GEHA Commercial |
$1,200.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,543.50
|
| Rate for Payer: Multiplan All |
$1,560.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,200.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,543.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,629.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,286.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,594.95
|
| Rate for Payer: Zelis Auto |
$686.00
|
| Rate for Payer: Zelis Worker's Compensation |
$468.19
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
6128153
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.64 |
| Max. Negotiated Rate |
$635.55 |
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cigna Commercial |
$568.65
|
| Rate for Payer: First Health Commercial |
$602.10
|
| Rate for Payer: First Health Workers Compensation |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$602.10
|
| Rate for Payer: GEHA Commercial |
$468.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$602.10
|
| Rate for Payer: Multiplan All |
$608.79
|
| Rate for Payer: OMNI Networks Commercial |
$468.30
|
| Rate for Payer: One Health Plan PPO/POS |
$602.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$635.55
|
| Rate for Payer: Three Rivers Provider Network All |
$501.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$622.17
|
| Rate for Payer: Zelis Auto |
$267.60
|
| Rate for Payer: Zelis Worker's Compensation |
$182.64
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
6128153
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.64 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$401.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cigna Commercial |
$568.65
|
| Rate for Payer: First Health Commercial |
$602.10
|
| Rate for Payer: First Health Workers Compensation |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$602.10
|
| Rate for Payer: GEHA Commercial |
$535.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$602.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$608.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$468.30
|
| Rate for Payer: One Health Plan PPO/POS |
$602.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$635.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$501.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$622.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$267.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$182.64
|
|
