|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 15946
|
| Hospital Charge Code |
6115946
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$916.73 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,014.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cigna Commercial |
$2,854.30
|
| Rate for Payer: First Health Commercial |
$3,022.20
|
| Rate for Payer: First Health Workers Compensation |
$1,296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,022.20
|
| Rate for Payer: GEHA Commercial |
$2,686.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,022.20
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$3,055.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,350.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,022.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,190.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$2,518.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,122.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$1,343.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$916.73
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
IP
|
$1,837.00
|
|
|
Service Code
|
CPT 15941
|
| Hospital Charge Code |
6115941
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$501.50 |
| Max. Negotiated Rate |
$1,745.15 |
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: Cigna Commercial |
$1,561.45
|
| Rate for Payer: First Health Commercial |
$1,653.30
|
| Rate for Payer: First Health Workers Compensation |
$709.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,653.30
|
| Rate for Payer: GEHA Commercial |
$1,285.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,653.30
|
| Rate for Payer: Multiplan All |
$1,671.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,285.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,653.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,745.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,377.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,708.41
|
| Rate for Payer: Zelis Auto |
$734.80
|
| Rate for Payer: Zelis Worker's Compensation |
$501.50
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 15940
|
| Hospital Charge Code |
6115940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$393.39 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$864.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cigna Commercial |
$1,224.85
|
| Rate for Payer: First Health Commercial |
$1,296.90
|
| Rate for Payer: First Health Workers Compensation |
$556.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,296.90
|
| Rate for Payer: GEHA Commercial |
$1,152.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,296.90
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,311.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,008.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,296.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,368.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,080.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,340.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$576.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$393.39
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
CPT 15945
|
| Hospital Charge Code |
6115945
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$545.18 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,198.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$1,198.20
|
| Rate for Payer: Cash Price |
$1,198.20
|
| Rate for Payer: Cigna Commercial |
$1,697.45
|
| Rate for Payer: First Health Commercial |
$1,797.30
|
| Rate for Payer: First Health Workers Compensation |
$771.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,797.30
|
| Rate for Payer: GEHA Commercial |
$1,597.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,797.30
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,817.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,397.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,797.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,897.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,497.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,857.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$798.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$545.18
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT 15945
|
| Hospital Charge Code |
6115945
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$545.18 |
| Max. Negotiated Rate |
$1,897.15 |
| Rate for Payer: Cash Price |
$1,198.20
|
| Rate for Payer: Cigna Commercial |
$1,697.45
|
| Rate for Payer: First Health Commercial |
$1,797.30
|
| Rate for Payer: First Health Workers Compensation |
$771.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,797.30
|
| Rate for Payer: GEHA Commercial |
$1,397.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,797.30
|
| Rate for Payer: Multiplan All |
$1,817.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,397.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,797.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,897.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,497.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,857.21
|
| Rate for Payer: Zelis Auto |
$798.80
|
| Rate for Payer: Zelis Worker's Compensation |
$545.18
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 15944
|
| Hospital Charge Code |
6115944
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$494.68 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,087.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Cigna Commercial |
$1,540.20
|
| Rate for Payer: First Health Commercial |
$1,630.80
|
| Rate for Payer: First Health Workers Compensation |
$699.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,630.80
|
| Rate for Payer: GEHA Commercial |
$1,449.60
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,630.80
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$1,648.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,268.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,630.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,721.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,359.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,685.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$724.80
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$494.68
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 15944
|
| Hospital Charge Code |
6115944
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$494.68 |
| Max. Negotiated Rate |
$1,721.40 |
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Cigna Commercial |
$1,540.20
|
| Rate for Payer: First Health Commercial |
$1,630.80
|
| Rate for Payer: First Health Workers Compensation |
$699.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,630.80
|
| Rate for Payer: GEHA Commercial |
$1,268.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,630.80
|
| Rate for Payer: Multiplan All |
$1,648.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,268.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,630.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,721.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,359.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,685.16
|
| Rate for Payer: Zelis Auto |
$724.80
|
| Rate for Payer: Zelis Worker's Compensation |
$494.68
|
|
|
REMOVE HUMERUS LESION
|
Facility
|
OP
|
$1,503.00
|
|
|
Service Code
|
CPT 23184
|
| Hospital Charge Code |
6123184
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.32 |
| 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 |
$901.80
|
| 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 |
$901.80
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cigna Commercial |
$1,277.55
|
| Rate for Payer: First Health Commercial |
$1,352.70
|
| Rate for Payer: First Health Workers Compensation |
$580.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,352.70
|
| Rate for Payer: GEHA Commercial |
$1,202.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,352.70
|
| 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 |
$1,367.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,352.70
|
| 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 |
$1,427.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,127.25
|
| 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 |
$1,397.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$601.20
|
| 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 |
$410.32
|
|
|
REMOVE HUMERUS LESION
|
Facility
|
IP
|
$1,534.00
|
|
|
Service Code
|
CPT 23174
|
| Hospital Charge Code |
6123174
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.78 |
| Max. Negotiated Rate |
$1,457.30 |
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cigna Commercial |
$1,303.90
|
| Rate for Payer: First Health Commercial |
$1,380.60
|
| Rate for Payer: First Health Workers Compensation |
$592.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,380.60
|
| Rate for Payer: GEHA Commercial |
$1,073.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,380.60
|
| Rate for Payer: Multiplan All |
$1,395.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,380.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,457.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,150.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,426.62
|
| Rate for Payer: Zelis Auto |
$613.60
|
| Rate for Payer: Zelis Worker's Compensation |
$418.78
|
|
|
REMOVE HUMERUS LESION
|
Facility
|
OP
|
$1,534.00
|
|
|
Service Code
|
CPT 23174
|
| Hospital Charge Code |
6123174
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.78 |
| 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 |
$920.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cigna Commercial |
$1,303.90
|
| Rate for Payer: First Health Commercial |
$1,380.60
|
| Rate for Payer: First Health Workers Compensation |
$592.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,380.60
|
| Rate for Payer: GEHA Commercial |
$1,227.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,380.60
|
| 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 |
$1,395.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,380.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,457.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,150.50
|
| 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 |
$1,426.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$613.60
|
| 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 |
$418.78
|
|
|
REMOVE HUMERUS LESION
|
Facility
|
IP
|
$1,503.00
|
|
|
Service Code
|
CPT 23184
|
| Hospital Charge Code |
6123184
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.32 |
| Max. Negotiated Rate |
$1,427.85 |
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cigna Commercial |
$1,277.55
|
| Rate for Payer: First Health Commercial |
$1,352.70
|
| Rate for Payer: First Health Workers Compensation |
$580.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,352.70
|
| Rate for Payer: GEHA Commercial |
$1,052.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,352.70
|
| Rate for Payer: Multiplan All |
$1,367.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,352.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,427.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,127.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,397.79
|
| Rate for Payer: Zelis Auto |
$601.20
|
| Rate for Payer: Zelis Worker's Compensation |
$410.32
|
|
|
REMOVE HUMERUS LESION
|
Facility
|
OP
|
$1,182.00
|
|
|
Service Code
|
CPT 24110
|
| Hospital Charge Code |
6124110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.69 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$1,004.70
|
| Rate for Payer: First Health Commercial |
$1,063.80
|
| Rate for Payer: First Health Workers Compensation |
$456.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,063.80
|
| Rate for Payer: GEHA Commercial |
$945.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,063.80
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,075.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$827.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,063.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,122.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$886.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,099.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$472.80
|
| 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 |
$322.69
|
|
|
REMOVE HUMERUS LESION
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 24110
|
| Hospital Charge Code |
6124110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.69 |
| Max. Negotiated Rate |
$1,122.90 |
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$1,004.70
|
| Rate for Payer: First Health Commercial |
$1,063.80
|
| Rate for Payer: First Health Workers Compensation |
$456.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,063.80
|
| Rate for Payer: GEHA Commercial |
$827.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,063.80
|
| Rate for Payer: Multiplan All |
$1,075.62
|
| Rate for Payer: OMNI Networks Commercial |
$827.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,063.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,122.90
|
| Rate for Payer: Three Rivers Provider Network All |
$886.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,099.26
|
| Rate for Payer: Zelis Auto |
$472.80
|
| Rate for Payer: Zelis Worker's Compensation |
$322.69
|
|
|
REMOVE IN/EX HEM GROUPS 2+
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
6146260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$833.00
|
| Rate for Payer: First Health Commercial |
$882.00
|
| Rate for Payer: First Health Workers Compensation |
$378.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.00
|
| Rate for Payer: GEHA Commercial |
$686.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.00
|
| Rate for Payer: Multiplan All |
$891.80
|
| Rate for Payer: OMNI Networks Commercial |
$686.00
|
| Rate for Payer: One Health Plan PPO/POS |
$882.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.00
|
| Rate for Payer: Three Rivers Provider Network All |
$735.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$911.40
|
| Rate for Payer: Zelis Auto |
$392.00
|
| Rate for Payer: Zelis Worker's Compensation |
$267.54
|
|
|
REMOVE IN/EX HEM GROUPS 2+
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
6146260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$833.00
|
| Rate for Payer: First Health Commercial |
$882.00
|
| Rate for Payer: First Health Workers Compensation |
$378.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.00
|
| Rate for Payer: GEHA Commercial |
$784.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.00
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$891.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$686.00
|
| Rate for Payer: One Health Plan PPO/POS |
$882.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$735.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$911.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$392.00
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$267.54
|
|
|
REMOVE IN/EX HEM GRP & FISS
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 46257
|
| Hospital Charge Code |
6146257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$693.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
REMOVE IN/EX HEM GRP & FISS
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 46257
|
| Hospital Charge Code |
6146257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$823.65 |
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$606.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
REMOVE IN/EX HEM GRPS & FISS
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 46261
|
| Hospital Charge Code |
6146261
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.29 |
| Max. Negotiated Rate |
$1,024.10 |
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: First Health Workers Compensation |
$416.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$754.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: Zelis Auto |
$431.20
|
| Rate for Payer: Zelis Worker's Compensation |
$294.29
|
|
|
REMOVE IN/EX HEM GRPS & FISS
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 46261
|
| Hospital Charge Code |
6146261
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.29 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$646.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: First Health Workers Compensation |
$416.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$862.40
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$431.20
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$294.29
|
|
|
REMOVE IN/EX HEM GRPS W/FIST
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 46262
|
| Hospital Charge Code |
6146262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$681.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cigna Commercial |
$965.60
|
| Rate for Payer: First Health Commercial |
$1,022.40
|
| Rate for Payer: First Health Workers Compensation |
$438.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,022.40
|
| Rate for Payer: GEHA Commercial |
$908.80
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,022.40
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,033.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$795.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,022.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,079.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$852.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,056.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$454.40
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$310.13
|
|
|
REMOVE IN/EX HEM GRPS W/FIST
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 46262
|
| Hospital Charge Code |
6146262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$1,079.20 |
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cigna Commercial |
$965.60
|
| Rate for Payer: First Health Commercial |
$1,022.40
|
| Rate for Payer: First Health Workers Compensation |
$438.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,022.40
|
| Rate for Payer: GEHA Commercial |
$795.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,022.40
|
| Rate for Payer: Multiplan All |
$1,033.76
|
| Rate for Payer: OMNI Networks Commercial |
$795.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,022.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,079.20
|
| Rate for Payer: Three Rivers Provider Network All |
$852.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,056.48
|
| Rate for Payer: Zelis Auto |
$454.40
|
| Rate for Payer: Zelis Worker's Compensation |
$310.13
|
|
|
REMOVE IN/EX HEM GRP W/FISTU
|
Facility
|
OP
|
$965.00
|
|
|
Service Code
|
CPT 46258
|
| Hospital Charge Code |
6146258
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.44 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$579.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$820.25
|
| Rate for Payer: First Health Commercial |
$868.50
|
| Rate for Payer: First Health Workers Compensation |
$372.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$868.50
|
| Rate for Payer: GEHA Commercial |
$772.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$868.50
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$878.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$675.50
|
| Rate for Payer: One Health Plan PPO/POS |
$868.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$916.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$723.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$897.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$386.00
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$263.44
|
|
|
REMOVE IN/EX HEM GRP W/FISTU
|
Facility
|
IP
|
$965.00
|
|
|
Service Code
|
CPT 46258
|
| Hospital Charge Code |
6146258
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.44 |
| Max. Negotiated Rate |
$916.75 |
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$820.25
|
| Rate for Payer: First Health Commercial |
$868.50
|
| Rate for Payer: First Health Workers Compensation |
$372.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$868.50
|
| Rate for Payer: GEHA Commercial |
$675.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$868.50
|
| Rate for Payer: Multiplan All |
$878.15
|
| Rate for Payer: OMNI Networks Commercial |
$675.50
|
| Rate for Payer: One Health Plan PPO/POS |
$868.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$916.75
|
| Rate for Payer: Three Rivers Provider Network All |
$723.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$897.45
|
| Rate for Payer: Zelis Auto |
$386.00
|
| Rate for Payer: Zelis Worker's Compensation |
$263.44
|
|
|
REMOVE INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$305.73
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
7258301
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$290.44 |
| Rate for Payer: Cash Price |
$183.44
|
| Rate for Payer: Cigna Commercial |
$259.87
|
| Rate for Payer: First Health Commercial |
$275.16
|
| Rate for Payer: First Health Workers Compensation |
$118.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$275.16
|
| Rate for Payer: GEHA Commercial |
$214.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$275.16
|
| Rate for Payer: Multiplan All |
$278.21
|
| Rate for Payer: OMNI Networks Commercial |
$214.01
|
| Rate for Payer: One Health Plan PPO/POS |
$275.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$290.44
|
| Rate for Payer: Three Rivers Provider Network All |
$229.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$284.33
|
| Rate for Payer: Zelis Auto |
$122.29
|
| Rate for Payer: Zelis Worker's Compensation |
$83.46
|
|
|
REMOVE INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$305.73
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
7258301
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$83.46 |
| 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 |
$183.44
|
| 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 |
$183.44
|
| Rate for Payer: Cash Price |
$183.44
|
| Rate for Payer: Cigna Commercial |
$259.87
|
| Rate for Payer: First Health Commercial |
$275.16
|
| Rate for Payer: First Health Workers Compensation |
$118.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$275.16
|
| Rate for Payer: GEHA Commercial |
$244.58
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$275.16
|
| 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 |
$278.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$214.01
|
| Rate for Payer: One Health Plan PPO/POS |
$275.16
|
| 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 |
$290.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$229.30
|
| 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 |
$284.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$122.29
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$83.46
|
|
