|
REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSUL
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
6111976
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: First Health Workers Compensation |
$112.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$203.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Worker's Compensation |
$79.44
|
|
|
REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$1,336.18
|
|
|
Service Code
|
CPT 11976
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$449.66 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$567.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$567.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$449.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$458.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$529.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$458.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$458.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$607.96
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
8720670
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.12 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$661.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,474.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$882.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,504.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,737.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,504.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,047.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,504.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,025.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$441.20
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$301.12
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
6120670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$269.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,474.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: First Health Workers Compensation |
$173.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$359.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,504.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,737.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,504.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,504.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$122.58
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
6120670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: First Health Workers Compensation |
$173.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$314.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Worker's Compensation |
$122.58
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
8720670
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.12 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$772.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,047.85
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,025.79
|
| Rate for Payer: Zelis Auto |
$441.20
|
| Rate for Payer: Zelis Worker's Compensation |
$301.12
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
8230002
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$301.12 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$661.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,474.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$882.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,504.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,737.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,504.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,047.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,504.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,025.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$441.20
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$301.12
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
OP
|
$7,012.50
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
9620670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$6,661.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,861.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,474.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$4,207.50
|
| Rate for Payer: Cash Price |
$4,207.50
|
| Rate for Payer: Cigna Commercial |
$5,960.62
|
| Rate for Payer: First Health Commercial |
$6,311.25
|
| Rate for Payer: First Health Workers Compensation |
$2,707.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,311.25
|
| Rate for Payer: GEHA Commercial |
$5,610.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,311.25
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,504.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$6,381.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,908.75
|
| Rate for Payer: One Health Plan PPO/POS |
$6,311.25
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,737.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,504.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,661.88
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$5,259.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,504.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,521.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,805.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,914.41
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
8230002
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$301.12 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$772.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,047.85
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,025.79
|
| Rate for Payer: Zelis Auto |
$441.20
|
| Rate for Payer: Zelis Worker's Compensation |
$301.12
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PRO
|
Facility
|
IP
|
$7,012.50
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
9620670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,914.41 |
| Max. Negotiated Rate |
$6,661.88 |
| Rate for Payer: Cash Price |
$4,207.50
|
| Rate for Payer: Cigna Commercial |
$5,960.62
|
| Rate for Payer: First Health Commercial |
$6,311.25
|
| Rate for Payer: First Health Workers Compensation |
$2,707.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,311.25
|
| Rate for Payer: GEHA Commercial |
$4,908.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,311.25
|
| Rate for Payer: Multiplan All |
$6,381.38
|
| Rate for Payer: OMNI Networks Commercial |
$4,908.75
|
| Rate for Payer: One Health Plan PPO/POS |
$6,311.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,661.88
|
| Rate for Payer: Three Rivers Provider Network All |
$5,259.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,521.62
|
| Rate for Payer: Zelis Auto |
$2,805.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,914.41
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
21600034
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
6158301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
21600034
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$678.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$537.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$548.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$633.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$548.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$1,054.00
|
|
| Hospital Charge Code |
8158301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: First Health Workers Compensation |
$406.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$843.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Humana ChoiceCare |
$274.04
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$632.40
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$927.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.00
|
| Rate for Payer: Zelis Worker's Compensation |
$287.74
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
23500069
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
6158301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$678.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$537.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$548.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$633.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$548.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
21558301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
23500069
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$678.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$537.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$548.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$633.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$548.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$1,054.00
|
|
| Hospital Charge Code |
8158301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.74 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: First Health Workers Compensation |
$406.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$737.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Worker's Compensation |
$287.74
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
21558301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$678.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$537.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$548.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$633.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$548.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
25500034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
25500034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$678.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$537.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$548.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$633.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$548.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
REMOVAL KIDNEY OPEN, RADICAL
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 50230
|
| Hospital Charge Code |
6150230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,519.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna Commercial |
$2,254.20
|
| Rate for Payer: First Health Commercial |
$2,386.80
|
| Rate for Payer: First Health Workers Compensation |
$1,023.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,386.80
|
| Rate for Payer: GEHA Commercial |
$2,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,386.80
|
| Rate for Payer: Humana ChoiceCare |
$689.52
|
| Rate for Payer: Multiplan All |
$2,413.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,591.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,856.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,386.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,519.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,989.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,333.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,466.36
|
| Rate for Payer: Zelis Auto |
$1,060.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,326.00
|
| Rate for Payer: Zelis Worker's Compensation |
$724.00
|
|
|
REMOVAL KIDNEY OPEN, RADICAL
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 50230
|
| Hospital Charge Code |
6150230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$2,519.40 |
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna Commercial |
$2,254.20
|
| Rate for Payer: First Health Commercial |
$2,386.80
|
| Rate for Payer: First Health Workers Compensation |
$1,023.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,386.80
|
| Rate for Payer: GEHA Commercial |
$1,856.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,386.80
|
| Rate for Payer: Multiplan All |
$2,413.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,856.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,386.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,519.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,989.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,466.36
|
| Rate for Payer: Zelis Auto |
$1,060.80
|
| Rate for Payer: Zelis Worker's Compensation |
$724.00
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 42830
|
| Hospital Charge Code |
6142830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cigna Commercial |
$452.20
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: First Health Workers Compensation |
$205.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$478.80
|
| Rate for Payer: GEHA Commercial |
$372.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$478.80
|
| Rate for Payer: Multiplan All |
$484.12
|
| Rate for Payer: OMNI Networks Commercial |
$372.40
|
| Rate for Payer: One Health Plan PPO/POS |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$505.40
|
| Rate for Payer: Three Rivers Provider Network All |
$399.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$494.76
|
| Rate for Payer: Zelis Auto |
$212.80
|
| Rate for Payer: Zelis Worker's Compensation |
$145.24
|
|
