|
PARTICAL MASTECTOMY
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
6119301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.01 |
| Max. Negotiated Rate |
$7,272.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$815.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cigna Commercial |
$1,155.15
|
| Rate for Payer: First Health Commercial |
$1,223.10
|
| Rate for Payer: First Health Workers Compensation |
$524.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,223.10
|
| Rate for Payer: GEHA Commercial |
$1,087.20
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,223.10
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: Multiplan All |
$1,236.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: OMNI Networks Commercial |
$951.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,223.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,291.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,019.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,263.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Auto |
$543.60
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$371.01
|
|
|
PART REMOVAL HIP BONE DEEP
|
Facility
|
IP
|
$1,877.00
|
|
|
Service Code
|
CPT 27071
|
| Hospital Charge Code |
6127071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.42 |
| Max. Negotiated Rate |
$1,783.15 |
| Rate for Payer: Cash Price |
$1,126.20
|
| Rate for Payer: Cigna Commercial |
$1,595.45
|
| Rate for Payer: First Health Commercial |
$1,689.30
|
| Rate for Payer: First Health Workers Compensation |
$724.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,689.30
|
| Rate for Payer: GEHA Commercial |
$1,313.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,689.30
|
| Rate for Payer: Multiplan All |
$1,708.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,313.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,689.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,783.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,407.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,745.61
|
| Rate for Payer: Zelis Auto |
$750.80
|
| Rate for Payer: Zelis Worker's Compensation |
$512.42
|
|
|
PART REMOVAL HIP BONE DEEP
|
Facility
|
OP
|
$1,877.00
|
|
|
Service Code
|
CPT 27071
|
| Hospital Charge Code |
6127071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$469.25 |
| Max. Negotiated Rate |
$1,783.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.20
|
| Rate for Payer: Cash Price |
$1,126.20
|
| Rate for Payer: Cigna Commercial |
$1,595.45
|
| Rate for Payer: First Health Commercial |
$1,689.30
|
| Rate for Payer: First Health Workers Compensation |
$724.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,689.30
|
| Rate for Payer: GEHA Commercial |
$1,501.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,689.30
|
| Rate for Payer: Humana ChoiceCare |
$488.02
|
| Rate for Payer: Multiplan All |
$1,708.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,126.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,313.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,689.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,783.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,407.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,651.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,745.61
|
| Rate for Payer: Zelis Auto |
$750.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$938.50
|
| Rate for Payer: Zelis Worker's Compensation |
$512.42
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
6128120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$278.19 |
| Max. Negotiated Rate |
$968.05 |
| Rate for Payer: Cash Price |
$611.40
|
| Rate for Payer: Cigna Commercial |
$866.15
|
| Rate for Payer: First Health Commercial |
$917.10
|
| Rate for Payer: First Health Workers Compensation |
$393.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$917.10
|
| Rate for Payer: GEHA Commercial |
$713.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$917.10
|
| Rate for Payer: Multiplan All |
$927.29
|
| Rate for Payer: OMNI Networks Commercial |
$713.30
|
| Rate for Payer: One Health Plan PPO/POS |
$917.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$968.05
|
| Rate for Payer: Three Rivers Provider Network All |
$764.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$947.67
|
| Rate for Payer: Zelis Auto |
$407.60
|
| Rate for Payer: Zelis Worker's Compensation |
$278.19
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
6128120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$278.19 |
| 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 |
$611.40
|
| 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 |
$611.40
|
| Rate for Payer: Cash Price |
$611.40
|
| Rate for Payer: Cigna Commercial |
$866.15
|
| Rate for Payer: First Health Commercial |
$917.10
|
| Rate for Payer: First Health Workers Compensation |
$393.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$917.10
|
| Rate for Payer: GEHA Commercial |
$815.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$917.10
|
| 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 |
$927.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$713.30
|
| Rate for Payer: One Health Plan PPO/POS |
$917.10
|
| 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 |
$968.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$764.25
|
| 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 |
$947.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$407.60
|
| 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 |
$278.19
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
6128111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.96 |
| 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 |
$501.00
|
| 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 |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$709.75
|
| Rate for Payer: First Health Commercial |
$751.50
|
| Rate for Payer: First Health Workers Compensation |
$322.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.50
|
| Rate for Payer: GEHA Commercial |
$668.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.50
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$759.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$584.50
|
| Rate for Payer: One Health Plan PPO/POS |
$751.50
|
| 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 |
$793.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$626.25
|
| 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 |
$776.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$334.00
|
| 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 |
$227.96
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
6128111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.96 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$709.75
|
| Rate for Payer: First Health Commercial |
$751.50
|
| Rate for Payer: First Health Workers Compensation |
$322.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.50
|
| Rate for Payer: GEHA Commercial |
$584.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.50
|
| Rate for Payer: Multiplan All |
$759.85
|
| Rate for Payer: OMNI Networks Commercial |
$584.50
|
| Rate for Payer: One Health Plan PPO/POS |
$751.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$793.25
|
| Rate for Payer: Three Rivers Provider Network All |
$626.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$776.55
|
| Rate for Payer: Zelis Auto |
$334.00
|
| Rate for Payer: Zelis Worker's Compensation |
$227.96
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
6128113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| 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 |
$518.40
|
| 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 |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$691.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| 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 |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| 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 |
$803.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$345.60
|
| 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 |
$235.87
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
6128110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.93 |
| 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 |
$441.60
|
| 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 |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$588.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| 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 |
$699.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| 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 |
$684.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$294.40
|
| 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 |
$200.93
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$1,324.71
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
6128112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$361.65 |
| Max. Negotiated Rate |
$1,258.47 |
| Rate for Payer: Cash Price |
$794.83
|
| Rate for Payer: Cigna Commercial |
$1,126.00
|
| Rate for Payer: First Health Commercial |
$1,192.24
|
| Rate for Payer: First Health Workers Compensation |
$511.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,192.24
|
| Rate for Payer: GEHA Commercial |
$927.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,192.24
|
| Rate for Payer: Multiplan All |
$1,205.49
|
| Rate for Payer: OMNI Networks Commercial |
$927.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,192.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,258.47
|
| Rate for Payer: Three Rivers Provider Network All |
$993.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,231.98
|
| Rate for Payer: Zelis Auto |
$529.88
|
| Rate for Payer: Zelis Worker's Compensation |
$361.65
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$1,324.71
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
6128112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$361.65 |
| 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 |
$794.83
|
| 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 |
$794.83
|
| Rate for Payer: Cash Price |
$794.83
|
| Rate for Payer: Cigna Commercial |
$1,126.00
|
| Rate for Payer: First Health Commercial |
$1,192.24
|
| Rate for Payer: First Health Workers Compensation |
$511.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,192.24
|
| Rate for Payer: GEHA Commercial |
$1,059.77
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,192.24
|
| 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 |
$1,205.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$927.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,192.24
|
| 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 |
$1,258.47
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$993.53
|
| 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 |
$1,231.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$529.88
|
| 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 |
$361.65
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
6128110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
6128113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$604.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
PART REMOVE HIP BONE SUPER
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
CPT 27070
|
| Hospital Charge Code |
6127070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.75 |
| Max. Negotiated Rate |
$1,648.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,041.00
|
| Rate for Payer: Cash Price |
$1,041.00
|
| Rate for Payer: Cigna Commercial |
$1,474.75
|
| Rate for Payer: First Health Commercial |
$1,561.50
|
| Rate for Payer: First Health Workers Compensation |
$669.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,561.50
|
| Rate for Payer: GEHA Commercial |
$1,388.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,561.50
|
| Rate for Payer: Humana ChoiceCare |
$451.10
|
| Rate for Payer: Multiplan All |
$1,578.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,041.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,214.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,561.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,648.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,301.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,526.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,613.55
|
| Rate for Payer: Zelis Auto |
$694.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$867.50
|
| Rate for Payer: Zelis Worker's Compensation |
$473.65
|
|
|
PART REMOVE HIP BONE SUPER
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
CPT 27070
|
| Hospital Charge Code |
6127070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.65 |
| Max. Negotiated Rate |
$1,648.25 |
| Rate for Payer: Cash Price |
$1,041.00
|
| Rate for Payer: Cigna Commercial |
$1,474.75
|
| Rate for Payer: First Health Commercial |
$1,561.50
|
| Rate for Payer: First Health Workers Compensation |
$669.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,561.50
|
| Rate for Payer: GEHA Commercial |
$1,214.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,561.50
|
| Rate for Payer: Multiplan All |
$1,578.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,214.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,561.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,648.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,301.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,613.55
|
| Rate for Payer: Zelis Auto |
$694.00
|
| Rate for Payer: Zelis Worker's Compensation |
$473.65
|
|
|
parvovirus b19 qual dna pcr REF138644
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2200149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
parvovirus b19 qual dna pcr REF138644
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2200149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$42.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$47.12
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$71.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.84
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.83
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$85.68
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.98
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.84
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$36.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.41
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
parvovirus b19 quant dna pcr REF139326
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2300110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
parvovirus b19 quant dna pcr REF139326
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2300110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$42.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$47.12
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$71.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.84
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.83
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$85.68
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.98
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.84
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$36.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.41
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
PATANOL OPTH SOLN 0.1%
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
NDC 00065027105
|
| Hospital Charge Code |
3300669
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$217.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$451.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| Rate for Payer: Humana ChoiceCare |
$146.64
|
| Rate for Payer: Multiplan All |
$513.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$338.40
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$496.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$141.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$524.52
|
| Rate for Payer: Zelis Auto |
$225.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$282.00
|
| Rate for Payer: Zelis Worker's Compensation |
$153.97
|
|
|
PATANOL OPTH SOLN 0.1%
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
NDC 00065027105
|
| Hospital Charge Code |
3300669
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.97 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$217.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$394.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| Rate for Payer: Multiplan All |
$513.24
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$524.52
|
| Rate for Payer: Zelis Auto |
$225.60
|
| Rate for Payer: Zelis Worker's Compensation |
$153.97
|
|
|
PATELLA,POLY,LOW PROFILE
|
Facility
|
OP
|
$4,165.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.25 |
| Max. Negotiated Rate |
$3,956.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,499.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cigna Commercial |
$3,540.25
|
| Rate for Payer: First Health Commercial |
$3,748.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,748.50
|
| Rate for Payer: GEHA Commercial |
$3,332.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,748.50
|
| Rate for Payer: Humana ChoiceCare |
$1,082.90
|
| Rate for Payer: Multiplan All |
$3,790.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,499.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,915.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,748.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,956.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,665.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,041.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,873.45
|
| Rate for Payer: Zelis Auto |
$1,666.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,082.50
|
|
|
PATELLA,POLY,LOW PROFILE
|
Facility
|
IP
|
$4,165.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,666.00 |
| Max. Negotiated Rate |
$3,956.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,332.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cigna Commercial |
$3,540.25
|
| Rate for Payer: First Health Commercial |
$3,748.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,748.50
|
| Rate for Payer: GEHA Commercial |
$2,915.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,748.50
|
| Rate for Payer: Multiplan All |
$3,790.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,915.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,748.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,956.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,873.45
|
| Rate for Payer: Zelis Auto |
$1,666.00
|
|
|
PATH CONSULT INTRAOP 1 BLOC FROZEN SECT1
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
2200171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$116.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$357.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$82.42
|
|
|
PATH CONSULT INTRAOP 1 BLOC FROZEN SECT1
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
2200171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$116.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$294.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Worker's Compensation |
$82.42
|
|
