|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8300065
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
REMVL AORTIC DEV VASC SEAL
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 0456T
|
| Hospital Charge Code |
6191041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
REMVL AORTIC DEV VASC SEAL
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 0456T
|
| Hospital Charge Code |
6191041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
REMVL AORTIC VENTR CMPL SYS
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 0455T
|
| Hospital Charge Code |
6191042
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
REMVL AORTIC VENTR CMPL SYS
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 0455T
|
| Hospital Charge Code |
6191042
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
REMVL IMPCTD VAG FB SPX W/ANES OTH/THN L
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
6157415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.68 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$187.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$340.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Worker's Compensation |
$132.68
|
|
|
REMVL IMPCTD VAG FB SPX W/ANES OTH/THN L
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
21600504
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
REMVL IMPCTD VAG FB SPX W/ANES OTH/THN L
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
21600504
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
REMVL IMPCTD VAG FB SPX W/ANES OTH/THN L
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
6157415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.68 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$187.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$388.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$132.68
|
|
|
REMVL INS IMPLTBL GLUC SENS
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 0448T
|
| Hospital Charge Code |
6191096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: First Health Commercial |
$621.00
|
| Rate for Payer: First Health Workers Compensation |
$266.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.00
|
| Rate for Payer: GEHA Commercial |
$483.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.00
|
| Rate for Payer: Multiplan All |
$627.90
|
| Rate for Payer: OMNI Networks Commercial |
$483.00
|
| Rate for Payer: One Health Plan PPO/POS |
$621.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.50
|
| Rate for Payer: Three Rivers Provider Network All |
$517.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.70
|
| Rate for Payer: Zelis Auto |
$276.00
|
| Rate for Payer: Zelis Worker's Compensation |
$188.37
|
|
|
REMVL INS IMPLTBL GLUC SENS
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 0448T
|
| Hospital Charge Code |
6191096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$6,172.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$679.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$679.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$538.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,086.48
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: First Health Commercial |
$621.00
|
| Rate for Payer: First Health Workers Compensation |
$266.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.00
|
| Rate for Payer: GEHA Commercial |
$552.00
|
| Rate for Payer: GEHA Medicare |
$3,086.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.00
|
| Rate for Payer: Humana ChoiceCare |
$3,395.13
|
| Rate for Payer: Humana Medicare Advantage |
$3,086.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,185.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$549.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,086.48
|
| Rate for Payer: Multiplan All |
$627.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,247.02
|
| Rate for Payer: OMNI Networks Commercial |
$483.00
|
| Rate for Payer: One Health Plan PPO/POS |
$621.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$634.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$549.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,086.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,172.96
|
| Rate for Payer: Three Rivers Provider Network All |
$517.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,024.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$549.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,086.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,086.48
|
| Rate for Payer: Zelis Auto |
$276.00
|
| Rate for Payer: Zelis Medicare |
$2,623.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,703.78
|
| Rate for Payer: Zelis Worker's Compensation |
$188.37
|
|
|
REMVL MECH-ELEC SKIN INTRFCE
|
Facility
|
OP
|
$3,895.00
|
|
|
Service Code
|
CPT 0457T
|
| Hospital Charge Code |
6191059
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$973.75 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: First Health Workers Compensation |
$1,503.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$3,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Humana ChoiceCare |
$1,012.70
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,337.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,427.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$973.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,947.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,063.34
|
|
|
REMVL MECH-ELEC SKIN INTRFCE
|
Facility
|
IP
|
$3,895.00
|
|
|
Service Code
|
CPT 0457T
|
| Hospital Charge Code |
6191059
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,063.34 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: First Health Workers Compensation |
$1,503.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$2,726.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,063.34
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
21599500
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$384.00
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
20311982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
21611982
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$384.00
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
21611982
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
OP
|
$309.51
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
7211982
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cigna Commercial |
$263.08
|
| Rate for Payer: First Health Commercial |
$278.56
|
| Rate for Payer: First Health Workers Compensation |
$119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.56
|
| Rate for Payer: GEHA Commercial |
$247.61
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.56
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$281.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$216.66
|
| Rate for Payer: One Health Plan PPO/POS |
$278.56
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$232.13
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$123.80
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$84.50
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
OP
|
$309.51
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
23500013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cigna Commercial |
$263.08
|
| Rate for Payer: First Health Commercial |
$278.56
|
| Rate for Payer: First Health Workers Compensation |
$119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.56
|
| Rate for Payer: GEHA Commercial |
$247.61
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.56
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$281.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$216.66
|
| Rate for Payer: One Health Plan PPO/POS |
$278.56
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$232.13
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$123.80
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$84.50
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
IP
|
$309.51
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
23500013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cigna Commercial |
$263.08
|
| Rate for Payer: First Health Commercial |
$278.56
|
| Rate for Payer: First Health Workers Compensation |
$119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.56
|
| Rate for Payer: GEHA Commercial |
$216.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.56
|
| Rate for Payer: Multiplan All |
$281.65
|
| Rate for Payer: OMNI Networks Commercial |
$216.66
|
| Rate for Payer: One Health Plan PPO/POS |
$278.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.03
|
| Rate for Payer: Three Rivers Provider Network All |
$232.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.84
|
| Rate for Payer: Zelis Auto |
$123.80
|
| Rate for Payer: Zelis Worker's Compensation |
$84.50
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
OP
|
$309.51
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
8511982
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cigna Commercial |
$263.08
|
| Rate for Payer: First Health Commercial |
$278.56
|
| Rate for Payer: First Health Workers Compensation |
$119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.56
|
| Rate for Payer: GEHA Commercial |
$247.61
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.56
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$281.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$216.66
|
| Rate for Payer: One Health Plan PPO/POS |
$278.56
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$232.13
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$123.80
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$84.50
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
IP
|
$309.51
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
7211982
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cigna Commercial |
$263.08
|
| Rate for Payer: First Health Commercial |
$278.56
|
| Rate for Payer: First Health Workers Compensation |
$119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.56
|
| Rate for Payer: GEHA Commercial |
$216.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.56
|
| Rate for Payer: Multiplan All |
$281.65
|
| Rate for Payer: OMNI Networks Commercial |
$216.66
|
| Rate for Payer: One Health Plan PPO/POS |
$278.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.03
|
| Rate for Payer: Three Rivers Provider Network All |
$232.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.84
|
| Rate for Payer: Zelis Auto |
$123.80
|
| Rate for Payer: Zelis Worker's Compensation |
$84.50
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
20311982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$384.00
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
IP
|
$309.51
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
8511982
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Cash Price |
$185.71
|
| Rate for Payer: Cigna Commercial |
$263.08
|
| Rate for Payer: First Health Commercial |
$278.56
|
| Rate for Payer: First Health Workers Compensation |
$119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.56
|
| Rate for Payer: GEHA Commercial |
$216.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.56
|
| Rate for Payer: Multiplan All |
$281.65
|
| Rate for Payer: OMNI Networks Commercial |
$216.66
|
| Rate for Payer: One Health Plan PPO/POS |
$278.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.03
|
| Rate for Payer: Three Rivers Provider Network All |
$232.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.84
|
| Rate for Payer: Zelis Auto |
$123.80
|
| Rate for Payer: Zelis Worker's Compensation |
$84.50
|
|
|
REMVL NON-BIODEGRADABLE DRG DELIVERY IMP
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
21599500
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
