|
RESECT SCAPULA TUMOR
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
CPT 23210
|
| Hospital Charge Code |
6123210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$3,491.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,205.00
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cigna Commercial |
$3,123.75
|
| Rate for Payer: First Health Commercial |
$3,307.50
|
| Rate for Payer: First Health Workers Compensation |
$1,418.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,307.50
|
| Rate for Payer: GEHA Commercial |
$2,940.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,307.50
|
| Rate for Payer: Humana ChoiceCare |
$955.50
|
| Rate for Payer: Multiplan All |
$3,344.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,205.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,572.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,307.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,491.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,756.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,234.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$918.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,417.75
|
| Rate for Payer: Zelis Auto |
$1,470.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,837.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,003.27
|
|
|
RESECT SHOULDER TUM < 5 CM
|
Facility
|
OP
|
$2,379.00
|
|
|
Service Code
|
CPT 23077
|
| Hospital Charge Code |
6123077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$649.47 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,427.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,427.40
|
| Rate for Payer: Cash Price |
$1,427.40
|
| Rate for Payer: Cigna Commercial |
$2,022.15
|
| Rate for Payer: First Health Commercial |
$2,141.10
|
| Rate for Payer: First Health Workers Compensation |
$918.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,141.10
|
| Rate for Payer: GEHA Commercial |
$1,903.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,141.10
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$2,164.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,665.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,141.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,260.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,784.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,212.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$951.60
|
| 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 |
$649.47
|
|
|
RESECT SHOULDER TUM < 5 CM
|
Facility
|
IP
|
$2,379.00
|
|
|
Service Code
|
CPT 23077
|
| Hospital Charge Code |
6123077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$649.47 |
| Max. Negotiated Rate |
$2,260.05 |
| Rate for Payer: Cash Price |
$1,427.40
|
| Rate for Payer: Cigna Commercial |
$2,022.15
|
| Rate for Payer: First Health Commercial |
$2,141.10
|
| Rate for Payer: First Health Workers Compensation |
$918.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,141.10
|
| Rate for Payer: GEHA Commercial |
$1,665.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,141.10
|
| Rate for Payer: Multiplan All |
$2,164.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,665.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,141.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,260.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,784.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,212.47
|
| Rate for Payer: Zelis Auto |
$951.60
|
| Rate for Payer: Zelis Worker's Compensation |
$649.47
|
|
|
RESECT SHOULDER TUM 5 CM/>
|
Facility
|
IP
|
$2,985.00
|
|
|
Service Code
|
CPT 23078
|
| Hospital Charge Code |
6123078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$814.90 |
| Max. Negotiated Rate |
$2,835.75 |
| Rate for Payer: Cash Price |
$1,791.00
|
| Rate for Payer: Cigna Commercial |
$2,537.25
|
| Rate for Payer: First Health Commercial |
$2,686.50
|
| Rate for Payer: First Health Workers Compensation |
$1,152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,686.50
|
| Rate for Payer: GEHA Commercial |
$2,089.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,686.50
|
| Rate for Payer: Multiplan All |
$2,716.35
|
| Rate for Payer: OMNI Networks Commercial |
$2,089.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,686.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,835.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,238.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,776.05
|
| Rate for Payer: Zelis Auto |
$1,194.00
|
| Rate for Payer: Zelis Worker's Compensation |
$814.90
|
|
|
RESECT SHOULDER TUM 5 CM/>
|
Facility
|
OP
|
$2,985.00
|
|
|
Service Code
|
CPT 23078
|
| Hospital Charge Code |
6123078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$814.90 |
| 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 |
$1,791.00
|
| 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 |
$1,791.00
|
| Rate for Payer: Cash Price |
$1,791.00
|
| Rate for Payer: Cigna Commercial |
$2,537.25
|
| Rate for Payer: First Health Commercial |
$2,686.50
|
| Rate for Payer: First Health Workers Compensation |
$1,152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,686.50
|
| Rate for Payer: GEHA Commercial |
$2,388.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,686.50
|
| 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 |
$2,716.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,089.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,686.50
|
| 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 |
$2,835.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,238.75
|
| 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 |
$2,776.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$1,194.00
|
| 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 |
$814.90
|
|
|
RESECT TALUS/CALCANEUS TUM
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 27647
|
| Hospital Charge Code |
6127647
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.03 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cigna Commercial |
$1,793.50
|
| Rate for Payer: First Health Commercial |
$1,899.00
|
| Rate for Payer: First Health Workers Compensation |
$814.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,899.00
|
| Rate for Payer: GEHA Commercial |
$1,688.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,899.00
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,920.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,477.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,899.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,004.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,582.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,962.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$844.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$576.03
|
|
|
RESECT TALUS/CALCANEUS TUM
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
CPT 27647
|
| Hospital Charge Code |
6127647
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.03 |
| Max. Negotiated Rate |
$2,004.50 |
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cigna Commercial |
$1,793.50
|
| Rate for Payer: First Health Commercial |
$1,899.00
|
| Rate for Payer: First Health Workers Compensation |
$814.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,899.00
|
| Rate for Payer: GEHA Commercial |
$1,477.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,899.00
|
| Rate for Payer: Multiplan All |
$1,920.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,477.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,899.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,004.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,582.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,962.30
|
| Rate for Payer: Zelis Auto |
$844.00
|
| Rate for Payer: Zelis Worker's Compensation |
$576.03
|
|
|
RESECT TARSAL TUMOR
|
Facility
|
IP
|
$1,746.00
|
|
|
Service Code
|
CPT 28171
|
| Hospital Charge Code |
6128171
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$476.66 |
| Max. Negotiated Rate |
$1,658.70 |
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,571.40
|
| Rate for Payer: First Health Workers Compensation |
$674.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,571.40
|
| Rate for Payer: GEHA Commercial |
$1,222.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,571.40
|
| Rate for Payer: Multiplan All |
$1,588.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,222.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,571.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,658.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,309.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,623.78
|
| Rate for Payer: Zelis Auto |
$698.40
|
| Rate for Payer: Zelis Worker's Compensation |
$476.66
|
|
|
RESECT TARSAL TUMOR
|
Facility
|
OP
|
$1,746.00
|
|
|
Service Code
|
CPT 28171
|
| Hospital Charge Code |
6128171
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$476.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,571.40
|
| Rate for Payer: First Health Workers Compensation |
$674.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,571.40
|
| Rate for Payer: GEHA Commercial |
$1,396.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,571.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,588.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,222.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,571.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,658.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,309.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,623.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$698.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$476.66
|
|
|
RESECT THIGH/KNEE TUM < 5 CM
|
Facility
|
IP
|
$2,148.00
|
|
|
Service Code
|
CPT 27329
|
| Hospital Charge Code |
6127329
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,503.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
RESECT THIGH/KNEE TUM < 5 CM
|
Facility
|
OP
|
$2,148.00
|
|
|
Service Code
|
CPT 27329
|
| Hospital Charge Code |
6127329
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,718.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$859.20
|
| 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 |
$586.40
|
|
|
RESECT THIGH/KNEE TUM 5 CM/>
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
CPT 27364
|
| Hospital Charge Code |
6127364
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$887.25 |
| 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 |
$1,950.00
|
| 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 |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$2,762.50
|
| Rate for Payer: First Health Commercial |
$2,925.00
|
| Rate for Payer: First Health Workers Compensation |
$1,254.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,925.00
|
| Rate for Payer: GEHA Commercial |
$2,600.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,925.00
|
| 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 |
$2,957.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,275.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,925.00
|
| 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 |
$3,087.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,437.50
|
| 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 |
$3,022.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$1,300.00
|
| 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 |
$887.25
|
|
|
RESECT THIGH/KNEE TUM 5 CM/>
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
CPT 27364
|
| Hospital Charge Code |
6127364
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$887.25 |
| Max. Negotiated Rate |
$3,087.50 |
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$2,762.50
|
| Rate for Payer: First Health Commercial |
$2,925.00
|
| Rate for Payer: First Health Workers Compensation |
$1,254.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,925.00
|
| Rate for Payer: GEHA Commercial |
$2,275.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,925.00
|
| Rate for Payer: Multiplan All |
$2,957.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,275.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,925.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,087.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,437.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,022.50
|
| Rate for Payer: Zelis Auto |
$1,300.00
|
| Rate for Payer: Zelis Worker's Compensation |
$887.25
|
|
|
RESECT TIBIA TUMOR
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
CPT 27645
|
| Hospital Charge Code |
6127645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,004.37 |
| Max. Negotiated Rate |
$3,495.05 |
| Rate for Payer: Cash Price |
$2,207.40
|
| Rate for Payer: Cigna Commercial |
$3,127.15
|
| Rate for Payer: First Health Commercial |
$3,311.10
|
| Rate for Payer: First Health Workers Compensation |
$1,420.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,311.10
|
| Rate for Payer: GEHA Commercial |
$2,575.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,311.10
|
| Rate for Payer: Multiplan All |
$3,347.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,575.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,311.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,495.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,759.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,421.47
|
| Rate for Payer: Zelis Auto |
$1,471.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,004.37
|
|
|
RESECT TIBIA TUMOR
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
CPT 27645
|
| Hospital Charge Code |
6127645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$919.75 |
| Max. Negotiated Rate |
$3,495.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,207.40
|
| Rate for Payer: Cash Price |
$2,207.40
|
| Rate for Payer: Cigna Commercial |
$3,127.15
|
| Rate for Payer: First Health Commercial |
$3,311.10
|
| Rate for Payer: First Health Workers Compensation |
$1,420.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,311.10
|
| Rate for Payer: GEHA Commercial |
$2,943.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,311.10
|
| Rate for Payer: Humana ChoiceCare |
$956.54
|
| Rate for Payer: Multiplan All |
$3,347.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,207.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,575.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,311.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,495.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,759.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,237.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$919.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,421.47
|
| Rate for Payer: Zelis Auto |
$1,471.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,839.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,004.37
|
|
|
RESET DISLOCATED JAW
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
6121480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
RESET DISLOCATED JAW
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 21485
|
| Hospital Charge Code |
6121485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.87 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$707.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna Commercial |
$1,002.15
|
| Rate for Payer: First Health Commercial |
$1,061.10
|
| Rate for Payer: First Health Workers Compensation |
$455.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,061.10
|
| Rate for Payer: GEHA Commercial |
$943.20
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,061.10
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,072.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$825.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,061.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,120.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$884.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,096.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$471.60
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$321.87
|
|
|
RESET DISLOCATED JAW
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
6121480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
RESET DISLOCATED JAW
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 21485
|
| Hospital Charge Code |
6121485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.87 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna Commercial |
$1,002.15
|
| Rate for Payer: First Health Commercial |
$1,061.10
|
| Rate for Payer: First Health Workers Compensation |
$455.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,061.10
|
| Rate for Payer: GEHA Commercial |
$825.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,061.10
|
| Rate for Payer: Multiplan All |
$1,072.89
|
| Rate for Payer: OMNI Networks Commercial |
$825.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,061.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,120.05
|
| Rate for Payer: Three Rivers Provider Network All |
$884.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,096.47
|
| Rate for Payer: Zelis Auto |
$471.60
|
| Rate for Payer: Zelis Worker's Compensation |
$321.87
|
|
|
resistance to thyroid hormone REF630540
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
2200151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.78 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$452.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$452.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$358.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$301.35
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$340.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$1,079.20
|
| Rate for Payer: GEHA Medicare |
$301.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Humana ChoiceCare |
$331.49
|
| Rate for Payer: Humana Medicare Advantage |
$301.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$506.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$365.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$301.35
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.29
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$421.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$365.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$301.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$602.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.32
|
| Rate for Payer: United Healthcare Commercial |
$1,146.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$365.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$301.35
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Medicare |
$256.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$361.62
|
| Rate for Payer: Zelis Worker's Compensation |
$240.78
|
|
|
resistance to thyroid hormone REF630540
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
2200151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.78 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$340.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$944.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Worker's Compensation |
$240.78
|
|
|
RESPIRATORY FLOW VOLUME LOOP
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
21600121
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
RESPIRATORY FLOW VOLUME LOOP
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
21600121
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
RESPIRATORY FLOW VOLUME LOOP
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
4094375
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$175.27 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cigna Commercial |
$545.70
|
| Rate for Payer: First Health Commercial |
$577.80
|
| Rate for Payer: First Health Workers Compensation |
$247.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$577.80
|
| Rate for Payer: GEHA Commercial |
$449.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$577.80
|
| Rate for Payer: Multiplan All |
$584.22
|
| Rate for Payer: OMNI Networks Commercial |
$449.40
|
| Rate for Payer: One Health Plan PPO/POS |
$577.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$609.90
|
| Rate for Payer: Three Rivers Provider Network All |
$481.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.06
|
| Rate for Payer: Zelis Auto |
$256.80
|
| Rate for Payer: Zelis Worker's Compensation |
$175.27
|
|
|
RESPIRATORY FLOW VOLUME LOOP
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
4094375
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$175.27 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$385.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cigna Commercial |
$545.70
|
| Rate for Payer: First Health Commercial |
$577.80
|
| Rate for Payer: First Health Workers Compensation |
$247.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$577.80
|
| Rate for Payer: GEHA Commercial |
$513.60
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$577.80
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$584.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$449.40
|
| Rate for Payer: One Health Plan PPO/POS |
$577.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$609.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$481.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Commercial |
$545.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$256.80
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$175.27
|
|
