|
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 |
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/REVIS CAST; BOOT/BODY
|
Facility
|
OP
|
$363.00
|
|
| Hospital Charge Code |
8129700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$308.55
|
| Rate for Payer: First Health Commercial |
$326.70
|
| Rate for Payer: First Health Workers Compensation |
$140.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.70
|
| Rate for Payer: GEHA Commercial |
$290.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.70
|
| Rate for Payer: Humana ChoiceCare |
$94.38
|
| Rate for Payer: Multiplan All |
$330.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.80
|
| Rate for Payer: OMNI Networks Commercial |
$254.10
|
| Rate for Payer: One Health Plan PPO/POS |
$326.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.85
|
| Rate for Payer: Three Rivers Provider Network All |
$272.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$319.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.59
|
| Rate for Payer: Zelis Auto |
$145.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.50
|
| Rate for Payer: Zelis Worker's Compensation |
$99.10
|
|
|
REMVL/REVIS CAST; BOOT/BODY
|
Facility
|
IP
|
$363.00
|
|
| Hospital Charge Code |
8129700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$308.55
|
| Rate for Payer: First Health Commercial |
$326.70
|
| Rate for Payer: First Health Workers Compensation |
$140.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.70
|
| Rate for Payer: GEHA Commercial |
$254.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.70
|
| Rate for Payer: Multiplan All |
$330.33
|
| Rate for Payer: OMNI Networks Commercial |
$254.10
|
| Rate for Payer: One Health Plan PPO/POS |
$326.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.85
|
| Rate for Payer: Three Rivers Provider Network All |
$272.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.59
|
| Rate for Payer: Zelis Auto |
$145.20
|
| Rate for Payer: Zelis Worker's Compensation |
$99.10
|
|
|
REMVL/REVIS CAST; FULL ARM/LEG
|
Facility
|
IP
|
$429.00
|
|
| Hospital Charge Code |
8129705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$364.65
|
| Rate for Payer: First Health Commercial |
$386.10
|
| Rate for Payer: First Health Workers Compensation |
$165.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.10
|
| Rate for Payer: GEHA Commercial |
$300.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.10
|
| Rate for Payer: Multiplan All |
$390.39
|
| Rate for Payer: OMNI Networks Commercial |
$300.30
|
| Rate for Payer: One Health Plan PPO/POS |
$386.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$407.55
|
| Rate for Payer: Three Rivers Provider Network All |
$321.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.97
|
| Rate for Payer: Zelis Auto |
$171.60
|
| Rate for Payer: Zelis Worker's Compensation |
$117.12
|
|
|
REMVL/REVIS CAST; FULL ARM/LEG
|
Facility
|
OP
|
$429.00
|
|
| Hospital Charge Code |
8129705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$364.65
|
| Rate for Payer: First Health Commercial |
$386.10
|
| Rate for Payer: First Health Workers Compensation |
$165.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.10
|
| Rate for Payer: GEHA Commercial |
$343.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.10
|
| Rate for Payer: Humana ChoiceCare |
$111.54
|
| Rate for Payer: Multiplan All |
$390.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.40
|
| Rate for Payer: OMNI Networks Commercial |
$300.30
|
| Rate for Payer: One Health Plan PPO/POS |
$386.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$407.55
|
| Rate for Payer: Three Rivers Provider Network All |
$321.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$377.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.97
|
| Rate for Payer: Zelis Auto |
$171.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$214.50
|
| Rate for Payer: Zelis Worker's Compensation |
$117.12
|
|
|
REMVL SUTRES/STAPLS REQUIRING ANESTHESIA
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
6115851
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: First Health Workers Compensation |
$54.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$113.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$56.80
|
| 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 |
$38.77
|
|
|
REMVL SUTRES/STAPLS REQUIRING ANESTHESIA
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
6115851
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: First Health Workers Compensation |
$54.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$99.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.77
|
|
|
REMV/REPLC PENIS PROS COMPL
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 54417
|
| Hospital Charge Code |
6154417
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$505.05 |
| Max. Negotiated Rate |
$24,673.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18,346.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18,346.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14,533.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,336.82
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,572.50
|
| Rate for Payer: First Health Commercial |
$1,665.00
|
| Rate for Payer: First Health Workers Compensation |
$714.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,665.00
|
| Rate for Payer: GEHA Commercial |
$1,480.00
|
| Rate for Payer: GEHA Medicare |
$12,336.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,665.00
|
| Rate for Payer: Humana ChoiceCare |
$13,570.50
|
| Rate for Payer: Humana Medicare Advantage |
$12,336.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,725.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14,829.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,336.82
|
| Rate for Payer: Multiplan All |
$1,683.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,972.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,295.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,665.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17,123.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14,829.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,336.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,757.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,673.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,387.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,090.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14,829.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,336.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,720.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,336.82
|
| Rate for Payer: Zelis Auto |
$740.00
|
| Rate for Payer: Zelis Medicare |
$10,486.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,804.18
|
| Rate for Payer: Zelis Worker's Compensation |
$505.05
|
|
|
REMV/REPLC PENIS PROS COMPL
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 54417
|
| Hospital Charge Code |
6154417
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$505.05 |
| Max. Negotiated Rate |
$1,757.50 |
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,572.50
|
| Rate for Payer: First Health Commercial |
$1,665.00
|
| Rate for Payer: First Health Workers Compensation |
$714.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,665.00
|
| Rate for Payer: GEHA Commercial |
$1,295.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,665.00
|
| Rate for Payer: Multiplan All |
$1,683.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,295.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,665.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,757.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,387.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,720.50
|
| Rate for Payer: Zelis Auto |
$740.00
|
| Rate for Payer: Zelis Worker's Compensation |
$505.05
|
|
|
REMV&REPLC PM GEN MULT LEADS
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
6133229
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$706.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Worker's Compensation |
$275.46
|
|
|
REMV&REPLC PM GEN MULT LEADS
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
6133229
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$36,217.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10,439.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$605.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10,439.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,269.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18,108.83
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: GEHA Medicare |
$18,108.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Humana ChoiceCare |
$19,919.71
|
| Rate for Payer: Humana Medicare Advantage |
$18,108.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30,422.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,438.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18,108.83
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30,785.01
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9,743.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,438.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18,108.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36,217.66
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,746.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,438.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,108.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18,108.83
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Medicare |
$15,392.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21,730.60
|
| Rate for Payer: Zelis Worker's Compensation |
$275.46
|
|
|
REMV/REPL PENIS CONTAIN PROS
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 54416
|
| Hospital Charge Code |
6154416
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.03 |
| Max. Negotiated Rate |
$38,225.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16,614.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$874.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16,614.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13,161.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,112.87
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$1,239.30
|
| Rate for Payer: First Health Commercial |
$1,312.20
|
| Rate for Payer: First Health Workers Compensation |
$562.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,312.20
|
| Rate for Payer: GEHA Commercial |
$1,166.40
|
| Rate for Payer: GEHA Medicare |
$19,112.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,312.20
|
| Rate for Payer: Humana ChoiceCare |
$21,024.16
|
| Rate for Payer: Humana Medicare Advantage |
$19,112.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,109.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13,429.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,112.87
|
| Rate for Payer: Multiplan All |
$1,326.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32,491.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,020.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,312.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15,506.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13,429.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,112.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,385.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38,225.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,093.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18,730.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13,429.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,112.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,112.87
|
| Rate for Payer: Zelis Auto |
$583.20
|
| Rate for Payer: Zelis Medicare |
$16,245.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22,935.44
|
| Rate for Payer: Zelis Worker's Compensation |
$398.03
|
|
|
REMV/REPL PENIS CONTAIN PROS
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 54416
|
| Hospital Charge Code |
6154416
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.03 |
| Max. Negotiated Rate |
$1,385.10 |
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$1,239.30
|
| Rate for Payer: First Health Commercial |
$1,312.20
|
| Rate for Payer: First Health Workers Compensation |
$562.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,312.20
|
| Rate for Payer: GEHA Commercial |
$1,020.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,312.20
|
| Rate for Payer: Multiplan All |
$1,326.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,020.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,312.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,385.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,093.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.94
|
| Rate for Payer: Zelis Auto |
$583.20
|
| Rate for Payer: Zelis Worker's Compensation |
$398.03
|
|
|
RENAL BIOPSY
|
Facility
|
IP
|
$1,576.00
|
|
| Hospital Charge Code |
2407225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.25 |
| Max. Negotiated Rate |
$1,497.20 |
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$1,339.60
|
| Rate for Payer: First Health Commercial |
$1,418.40
|
| Rate for Payer: First Health Workers Compensation |
$608.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,418.40
|
| Rate for Payer: GEHA Commercial |
$1,103.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,418.40
|
| Rate for Payer: Multiplan All |
$1,434.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,418.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,497.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,465.68
|
| Rate for Payer: Zelis Auto |
$630.40
|
| Rate for Payer: Zelis Worker's Compensation |
$430.25
|
|
|
RENAL BIOPSY
|
Facility
|
OP
|
$1,576.00
|
|
| Hospital Charge Code |
2407225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$394.00 |
| Max. Negotiated Rate |
$1,497.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$1,339.60
|
| Rate for Payer: First Health Commercial |
$1,418.40
|
| Rate for Payer: First Health Workers Compensation |
$608.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,418.40
|
| Rate for Payer: GEHA Commercial |
$1,260.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,418.40
|
| Rate for Payer: Humana ChoiceCare |
$409.76
|
| Rate for Payer: Multiplan All |
$1,434.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$945.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,418.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,497.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,386.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,465.68
|
| Rate for Payer: Zelis Auto |
$630.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$788.00
|
| Rate for Payer: Zelis Worker's Compensation |
$430.25
|
|
|
RENAL PANEL (Vitros)
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
2232207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.68
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$261.80
|
| Rate for Payer: First Health Commercial |
$277.20
|
| Rate for Payer: First Health Workers Compensation |
$15.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$277.20
|
| Rate for Payer: GEHA Commercial |
$246.40
|
| Rate for Payer: GEHA Medicare |
$8.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$277.20
|
| Rate for Payer: Humana ChoiceCare |
$9.55
|
| Rate for Payer: Humana Medicare Advantage |
$8.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.68
|
| Rate for Payer: Multiplan All |
$280.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.76
|
| Rate for Payer: OMNI Networks Commercial |
$215.60
|
| Rate for Payer: One Health Plan PPO/POS |
$277.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$292.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.36
|
| Rate for Payer: Three Rivers Provider Network All |
$231.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.51
|
| Rate for Payer: United Healthcare Commercial |
$261.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$286.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.68
|
| Rate for Payer: Zelis Auto |
$123.20
|
| Rate for Payer: Zelis Medicare |
$7.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.42
|
| Rate for Payer: Zelis Worker's Compensation |
$10.63
|
|
|
RENAL PANEL (Vitros)
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
2232207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$261.80
|
| Rate for Payer: First Health Commercial |
$277.20
|
| Rate for Payer: First Health Workers Compensation |
$15.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$277.20
|
| Rate for Payer: GEHA Commercial |
$215.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$277.20
|
| Rate for Payer: Multiplan All |
$280.28
|
| Rate for Payer: OMNI Networks Commercial |
$215.60
|
| Rate for Payer: One Health Plan PPO/POS |
$277.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$292.60
|
| Rate for Payer: Three Rivers Provider Network All |
$231.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$286.44
|
| Rate for Payer: Zelis Auto |
$123.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.63
|
|
|
RENAL SCOPE W/TUMOR RESECT
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT 50562
|
| Hospital Charge Code |
6150562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.69 |
| Max. Negotiated Rate |
$17,561.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,780.54
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: First Health Workers Compensation |
$464.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: GEHA Medicare |
$8,780.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$9,658.59
|
| Rate for Payer: Humana Medicare Advantage |
$8,780.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,751.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,780.54
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,926.92
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,780.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,561.08
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,604.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,780.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,780.54
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Medicare |
$7,463.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,536.65
|
| Rate for Payer: Zelis Worker's Compensation |
$328.69
|
|
|
RENAL SCOPE W/TUMOR RESECT
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT 50562
|
| Hospital Charge Code |
6150562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.69 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: First Health Workers Compensation |
$464.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Worker's Compensation |
$328.69
|
|
|
renin activity plasma REF002006
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
22990754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$38.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$175.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.04
|
|
|
renin activity plasma REF002006
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
22990754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$39.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$39.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.99
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$38.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: GEHA Medicare |
$21.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$24.19
|
| Rate for Payer: Humana Medicare Advantage |
$21.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$36.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$32.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.99
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37.38
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$36.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$43.98
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.55
|
| Rate for Payer: United Healthcare Commercial |
$213.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.99
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Medicare |
$18.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.39
|
| Rate for Payer: Zelis Worker's Compensation |
$27.04
|
|
|
REOPENING OF ABDOMEN
|
Facility
|
IP
|
$3,106.44
|
|
|
Service Code
|
CPT 49002
|
| Hospital Charge Code |
6149002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$848.06 |
| Max. Negotiated Rate |
$2,951.12 |
| Rate for Payer: Cash Price |
$1,863.86
|
| Rate for Payer: Cigna Commercial |
$2,640.47
|
| Rate for Payer: First Health Commercial |
$2,795.80
|
| Rate for Payer: First Health Workers Compensation |
$1,199.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,795.80
|
| Rate for Payer: GEHA Commercial |
$2,174.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,795.80
|
| Rate for Payer: Multiplan All |
$2,826.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,174.51
|
| Rate for Payer: One Health Plan PPO/POS |
$2,795.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,951.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,329.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,888.99
|
| Rate for Payer: Zelis Auto |
$1,242.58
|
| Rate for Payer: Zelis Worker's Compensation |
$848.06
|
|
|
REOPENING OF ABDOMEN
|
Facility
|
OP
|
$3,106.44
|
|
|
Service Code
|
CPT 49002
|
| Hospital Charge Code |
6149002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$776.61 |
| Max. Negotiated Rate |
$2,951.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,863.86
|
| Rate for Payer: Cash Price |
$1,863.86
|
| Rate for Payer: Cigna Commercial |
$2,640.47
|
| Rate for Payer: First Health Commercial |
$2,795.80
|
| Rate for Payer: First Health Workers Compensation |
$1,199.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,795.80
|
| Rate for Payer: GEHA Commercial |
$2,485.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,795.80
|
| Rate for Payer: Humana ChoiceCare |
$807.67
|
| Rate for Payer: Multiplan All |
$2,826.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,863.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,174.51
|
| Rate for Payer: One Health Plan PPO/POS |
$2,795.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,951.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,329.83
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,733.67
|
| Rate for Payer: United Healthcare Managed Medicaid |
$776.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,888.99
|
| Rate for Payer: Zelis Auto |
$1,242.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,553.22
|
| Rate for Payer: Zelis Worker's Compensation |
$848.06
|
|
|
REPAIR ACHILLES TENDON
|
Facility
|
IP
|
$1,930.38
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
6127650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$526.99 |
| Max. Negotiated Rate |
$1,833.86 |
| Rate for Payer: Cash Price |
$1,158.23
|
| Rate for Payer: Cigna Commercial |
$1,640.82
|
| Rate for Payer: First Health Commercial |
$1,737.34
|
| Rate for Payer: First Health Workers Compensation |
$745.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.34
|
| Rate for Payer: GEHA Commercial |
$1,351.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.34
|
| Rate for Payer: Multiplan All |
$1,756.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.27
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,833.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,447.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,795.25
|
| Rate for Payer: Zelis Auto |
$772.15
|
| Rate for Payer: Zelis Worker's Compensation |
$526.99
|
|
