|
RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL N
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
21600227
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
6145915
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.61 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: First Health Workers Compensation |
$224.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.90
|
| Rate for Payer: GEHA Commercial |
$464.80
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.90
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$528.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$406.70
|
| Rate for Payer: One Health Plan PPO/POS |
$522.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$435.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$540.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$232.40
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$158.61
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
21600495
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$280.10 |
| Max. Negotiated Rate |
$974.70 |
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$872.10
|
| Rate for Payer: First Health Commercial |
$923.40
|
| Rate for Payer: First Health Workers Compensation |
$396.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$923.40
|
| Rate for Payer: GEHA Commercial |
$718.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$923.40
|
| Rate for Payer: Multiplan All |
$933.66
|
| Rate for Payer: OMNI Networks Commercial |
$718.20
|
| Rate for Payer: One Health Plan PPO/POS |
$923.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$974.70
|
| Rate for Payer: Three Rivers Provider Network All |
$769.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$954.18
|
| Rate for Payer: Zelis Auto |
$410.40
|
| Rate for Payer: Zelis Worker's Compensation |
$280.10
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
21600495
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$280.10 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$872.10
|
| Rate for Payer: First Health Commercial |
$923.40
|
| Rate for Payer: First Health Workers Compensation |
$396.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$923.40
|
| Rate for Payer: GEHA Commercial |
$820.80
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$923.40
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$933.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$718.20
|
| Rate for Payer: One Health Plan PPO/POS |
$923.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$769.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$954.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$410.40
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$280.10
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
6145915
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.61 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: First Health Workers Compensation |
$224.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.90
|
| Rate for Payer: GEHA Commercial |
$406.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.90
|
| Rate for Payer: Multiplan All |
$528.71
|
| Rate for Payer: OMNI Networks Commercial |
$406.70
|
| Rate for Payer: One Health Plan PPO/POS |
$522.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.95
|
| Rate for Payer: Three Rivers Provider Network All |
$435.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$540.33
|
| Rate for Payer: Zelis Auto |
$232.40
|
| Rate for Payer: Zelis Worker's Compensation |
$158.61
|
|
|
RMVL FOREIGN BODY MUS/TEN SHEATH DEEP/CO
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
21600491
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$390.39 |
| Max. Negotiated Rate |
$1,358.50 |
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cigna Commercial |
$1,215.50
|
| Rate for Payer: First Health Commercial |
$1,287.00
|
| Rate for Payer: First Health Workers Compensation |
$552.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,287.00
|
| Rate for Payer: GEHA Commercial |
$1,001.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,287.00
|
| Rate for Payer: Multiplan All |
$1,301.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,001.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,287.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,358.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,072.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,329.90
|
| Rate for Payer: Zelis Auto |
$572.00
|
| Rate for Payer: Zelis Worker's Compensation |
$390.39
|
|
|
RMVL FOREIGN BODY MUS/TEN SHEATH DEEP/CO
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
6120525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$173.90 |
| 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 |
$382.20
|
| 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 |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| 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 |
$579.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| 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 |
$605.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| 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 |
$592.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$254.80
|
| 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 |
$173.90
|
|
|
RMVL FOREIGN BODY MUS/TEN SHEATH DEEP/CO
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
21600491
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$390.39 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$858.00
|
| 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 |
$858.00
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cigna Commercial |
$1,215.50
|
| Rate for Payer: First Health Commercial |
$1,287.00
|
| Rate for Payer: First Health Workers Compensation |
$552.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,287.00
|
| Rate for Payer: GEHA Commercial |
$1,144.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,287.00
|
| 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 |
$1,301.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,001.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,287.00
|
| 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 |
$1,358.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,072.50
|
| 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 |
$1,329.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$572.00
|
| 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 |
$390.39
|
|
|
RMVL FOREIGN BODY MUS/TEN SHEATH DEEP/CO
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
6120525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$445.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Worker's Compensation |
$173.90
|
|
|
RMVL FOREIGN BODY PELVIS/HIP SUBQ TISS
|
Facility
|
IP
|
$4,811.00
|
|
| Hospital Charge Code |
8127086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$4,570.45 |
| Rate for Payer: Cash Price |
$2,886.60
|
| Rate for Payer: Cigna Commercial |
$4,089.35
|
| Rate for Payer: First Health Commercial |
$4,329.90
|
| Rate for Payer: First Health Workers Compensation |
$1,857.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,329.90
|
| Rate for Payer: GEHA Commercial |
$3,367.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,329.90
|
| Rate for Payer: Multiplan All |
$4,378.01
|
| Rate for Payer: OMNI Networks Commercial |
$3,367.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,329.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,570.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,608.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,474.23
|
| Rate for Payer: Zelis Auto |
$1,924.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,313.40
|
|
|
RMVL FOREIGN BODY PELVIS/HIP SUBQ TISS
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
6127086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$302.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| 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 |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$201.60
|
| 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 |
$137.59
|
|
|
RMVL FOREIGN BODY PELVIS/HIP SUBQ TISS
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
21600483
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: First Health Workers Compensation |
$348.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| 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 |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$361.20
|
| 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 |
$246.52
|
|
|
RMVL FOREIGN BODY PELVIS/HIP SUBQ TISS
|
Facility
|
OP
|
$4,811.00
|
|
| Hospital Charge Code |
8127086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,202.75 |
| Max. Negotiated Rate |
$4,570.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,886.60
|
| Rate for Payer: Cash Price |
$2,886.60
|
| Rate for Payer: Cigna Commercial |
$4,089.35
|
| Rate for Payer: First Health Commercial |
$4,329.90
|
| Rate for Payer: First Health Workers Compensation |
$1,857.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,329.90
|
| Rate for Payer: GEHA Commercial |
$3,848.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,329.90
|
| Rate for Payer: Humana ChoiceCare |
$1,250.86
|
| Rate for Payer: Multiplan All |
$4,378.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,886.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,367.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,329.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,570.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,608.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,233.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,202.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,474.23
|
| Rate for Payer: Zelis Auto |
$1,924.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,405.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,313.40
|
|
|
RMVL FOREIGN BODY PELVIS/HIP SUBQ TISS
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
21600483
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$857.85 |
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: First Health Workers Compensation |
$348.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$632.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: Zelis Auto |
$361.20
|
| Rate for Payer: Zelis Worker's Compensation |
$246.52
|
|
|
RMVL FOREIGN BODY PELVIS/HIP SUBQ TISS
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
6127086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
RMVL FOREIGN BODY UPPER ARM/ELBOW SUBQ
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
6124200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$404.70 |
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna Commercial |
$362.10
|
| Rate for Payer: First Health Commercial |
$383.40
|
| Rate for Payer: First Health Workers Compensation |
$164.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$383.40
|
| Rate for Payer: GEHA Commercial |
$298.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$383.40
|
| Rate for Payer: Multiplan All |
$387.66
|
| Rate for Payer: OMNI Networks Commercial |
$298.20
|
| Rate for Payer: One Health Plan PPO/POS |
$383.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$404.70
|
| Rate for Payer: Three Rivers Provider Network All |
$319.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$396.18
|
| Rate for Payer: Zelis Auto |
$170.40
|
| Rate for Payer: Zelis Worker's Compensation |
$116.30
|
|
|
RMVL FOREIGN BODY UPPER ARM/ELBOW SUBQ
|
Facility
|
OP
|
$1,889.00
|
|
| Hospital Charge Code |
8124200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.25 |
| Max. Negotiated Rate |
$1,794.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,133.40
|
| Rate for Payer: Cash Price |
$1,133.40
|
| Rate for Payer: Cigna Commercial |
$1,605.65
|
| Rate for Payer: First Health Commercial |
$1,700.10
|
| Rate for Payer: First Health Workers Compensation |
$729.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,700.10
|
| Rate for Payer: GEHA Commercial |
$1,511.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,700.10
|
| Rate for Payer: Humana ChoiceCare |
$491.14
|
| Rate for Payer: Multiplan All |
$1,718.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,133.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,322.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,700.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,794.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,416.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,662.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,756.77
|
| Rate for Payer: Zelis Auto |
$755.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$944.50
|
| Rate for Payer: Zelis Worker's Compensation |
$515.70
|
|
|
RMVL FOREIGN BODY UPPER ARM/ELBOW SUBQ
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
6124200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$255.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna Commercial |
$362.10
|
| Rate for Payer: First Health Commercial |
$383.40
|
| Rate for Payer: First Health Workers Compensation |
$164.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$383.40
|
| Rate for Payer: GEHA Commercial |
$340.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$383.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$387.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$298.20
|
| Rate for Payer: One Health Plan PPO/POS |
$383.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$404.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$319.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$396.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$170.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$116.30
|
|
|
RMVL FOREIGN BODY UPPER ARM/ELBOW SUBQ
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
21600166
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$255.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna Commercial |
$362.10
|
| Rate for Payer: First Health Commercial |
$383.40
|
| Rate for Payer: First Health Workers Compensation |
$164.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$383.40
|
| Rate for Payer: GEHA Commercial |
$340.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$383.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$387.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$298.20
|
| Rate for Payer: One Health Plan PPO/POS |
$383.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$404.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$319.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$396.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$170.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$116.30
|
|
|
RMVL FOREIGN BODY UPPER ARM/ELBOW SUBQ
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
21600166
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$404.70 |
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna Commercial |
$362.10
|
| Rate for Payer: First Health Commercial |
$383.40
|
| Rate for Payer: First Health Workers Compensation |
$164.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$383.40
|
| Rate for Payer: GEHA Commercial |
$298.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$383.40
|
| Rate for Payer: Multiplan All |
$387.66
|
| Rate for Payer: OMNI Networks Commercial |
$298.20
|
| Rate for Payer: One Health Plan PPO/POS |
$383.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$404.70
|
| Rate for Payer: Three Rivers Provider Network All |
$319.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$396.18
|
| Rate for Payer: Zelis Auto |
$170.40
|
| Rate for Payer: Zelis Worker's Compensation |
$116.30
|
|
|
RMVL FOREIGN BODY UPPER ARM/ELBOW SUBQ
|
Facility
|
IP
|
$1,889.00
|
|
| Hospital Charge Code |
8124200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$515.70 |
| Max. Negotiated Rate |
$1,794.55 |
| Rate for Payer: Cash Price |
$1,133.40
|
| Rate for Payer: Cigna Commercial |
$1,605.65
|
| Rate for Payer: First Health Commercial |
$1,700.10
|
| Rate for Payer: First Health Workers Compensation |
$729.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,700.10
|
| Rate for Payer: GEHA Commercial |
$1,322.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,700.10
|
| Rate for Payer: Multiplan All |
$1,718.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,322.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,700.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,794.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,416.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,756.77
|
| Rate for Payer: Zelis Auto |
$755.60
|
| Rate for Payer: Zelis Worker's Compensation |
$515.70
|
|
|
RMVL IMPLTBL GLUCOSE SENSOR
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 0447T
|
| Hospital Charge Code |
6191090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$198.05
|
| Rate for Payer: First Health Commercial |
$209.70
|
| Rate for Payer: First Health Workers Compensation |
$89.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$209.70
|
| Rate for Payer: GEHA Commercial |
$163.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$209.70
|
| Rate for Payer: Multiplan All |
$212.03
|
| Rate for Payer: OMNI Networks Commercial |
$163.10
|
| Rate for Payer: One Health Plan PPO/POS |
$209.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$221.35
|
| Rate for Payer: Three Rivers Provider Network All |
$174.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$216.69
|
| Rate for Payer: Zelis Auto |
$93.20
|
| Rate for Payer: Zelis Worker's Compensation |
$63.61
|
|
|
RMVL IMPLTBL GLUCOSE SENSOR
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 0447T
|
| Hospital Charge Code |
6191090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$229.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$229.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$181.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$198.05
|
| Rate for Payer: First Health Commercial |
$209.70
|
| Rate for Payer: First Health Workers Compensation |
$89.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$209.70
|
| Rate for Payer: GEHA Commercial |
$186.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$209.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$185.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$212.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$163.10
|
| Rate for Payer: One Health Plan PPO/POS |
$209.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$214.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$185.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$221.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$174.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$185.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$216.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$93.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.61
|
|
|
RMVL NDWELLG TUNNELD PLEURAL CATH W/CUFF
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
6132552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$190.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$134.86
|
|
|
RMVL NDWELLG TUNNELD PLEURAL CATH W/CUFF
|
Facility
|
OP
|
$3,309.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
7732552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$3,143.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,985.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$2,812.65
|
| Rate for Payer: First Health Commercial |
$2,978.10
|
| Rate for Payer: First Health Workers Compensation |
$755.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,978.10
|
| Rate for Payer: GEHA Commercial |
$2,647.20
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,978.10
|
| Rate for Payer: Humana ChoiceCare |
$645.77
|
| Rate for Payer: Humana Medicare Advantage |
$587.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$986.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$472.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$3,011.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,316.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,978.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$545.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$472.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,143.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,481.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,077.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$1,323.60
|
| Rate for Payer: Zelis Medicare |
$499.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.47
|
| Rate for Payer: Zelis Worker's Compensation |
$534.22
|
|
