|
SPLINTS
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
8504570
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$67.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$139.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| Rate for Payer: Humana ChoiceCare |
$45.24
|
| Rate for Payer: Multiplan All |
$158.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$104.40
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$165.30
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$153.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$161.82
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$87.00
|
| Rate for Payer: Zelis Worker's Compensation |
$47.50
|
|
|
SPLINTS
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
8504570
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$67.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$121.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| Rate for Payer: Multiplan All |
$158.34
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$165.30
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$161.82
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Worker's Compensation |
$47.50
|
|
|
SPLIT AGRFT FSNHFGMD GT 1ST 100 CM/</1%
|
Facility
|
IP
|
$2,445.87
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
6115120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$2,323.58 |
| Rate for Payer: Cash Price |
$1,467.52
|
| Rate for Payer: Cigna Commercial |
$2,078.99
|
| Rate for Payer: First Health Commercial |
$2,201.28
|
| Rate for Payer: First Health Workers Compensation |
$944.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,201.28
|
| Rate for Payer: GEHA Commercial |
$1,712.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,201.28
|
| Rate for Payer: Multiplan All |
$2,225.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,712.11
|
| Rate for Payer: One Health Plan PPO/POS |
$2,201.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,323.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,834.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,274.66
|
| Rate for Payer: Zelis Auto |
$978.35
|
| Rate for Payer: Zelis Worker's Compensation |
$667.72
|
|
|
SPLIT AGRFT FSNHFGMD GT 1ST 100 CM/</1%
|
Facility
|
OP
|
$2,445.87
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
6115120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,467.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$1,467.52
|
| Rate for Payer: Cash Price |
$1,467.52
|
| Rate for Payer: Cigna Commercial |
$2,078.99
|
| Rate for Payer: First Health Commercial |
$2,201.28
|
| Rate for Payer: First Health Workers Compensation |
$944.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,201.28
|
| Rate for Payer: GEHA Commercial |
$1,956.70
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,201.28
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$2,225.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,712.11
|
| Rate for Payer: One Health Plan PPO/POS |
$2,201.28
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,323.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,834.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,274.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$978.35
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$667.72
|
|
|
SPLIT AGRFT FSNHFGMD GT 1ST 100 CM/</1%
|
Facility
|
IP
|
$9,778.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
1915120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,669.39 |
| Max. Negotiated Rate |
$9,289.10 |
| Rate for Payer: Cash Price |
$5,866.80
|
| Rate for Payer: Cigna Commercial |
$8,311.30
|
| Rate for Payer: First Health Commercial |
$8,800.20
|
| Rate for Payer: First Health Workers Compensation |
$3,775.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,800.20
|
| Rate for Payer: GEHA Commercial |
$6,844.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,800.20
|
| Rate for Payer: Multiplan All |
$8,897.98
|
| Rate for Payer: OMNI Networks Commercial |
$6,844.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,800.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,289.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,333.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,093.54
|
| Rate for Payer: Zelis Auto |
$3,911.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,669.39
|
|
|
SPLIT AGRFT FSNHFGMD GT 1ST 100 CM/</1%
|
Facility
|
OP
|
$9,778.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
1915120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,916.89 |
| Max. Negotiated Rate |
$9,289.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,866.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$5,866.80
|
| Rate for Payer: Cash Price |
$5,866.80
|
| Rate for Payer: Cigna Commercial |
$8,311.30
|
| Rate for Payer: First Health Commercial |
$8,800.20
|
| Rate for Payer: First Health Workers Compensation |
$3,775.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,800.20
|
| Rate for Payer: GEHA Commercial |
$7,822.40
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,800.20
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$8,897.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$6,844.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,800.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,289.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$7,333.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,093.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$3,911.20
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$2,669.39
|
|
|
SPLIT AGRFT FSNHFGMD GT 1ST 100 CM/</1%
|
Facility
|
IP
|
$2,603.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
20300118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$710.62 |
| Max. Negotiated Rate |
$2,472.85 |
| Rate for Payer: Cash Price |
$1,561.80
|
| Rate for Payer: Cigna Commercial |
$2,212.55
|
| Rate for Payer: First Health Commercial |
$2,342.70
|
| Rate for Payer: First Health Workers Compensation |
$1,005.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,342.70
|
| Rate for Payer: GEHA Commercial |
$1,822.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,342.70
|
| Rate for Payer: Multiplan All |
$2,368.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,822.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,342.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,472.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,952.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,420.79
|
| Rate for Payer: Zelis Auto |
$1,041.20
|
| Rate for Payer: Zelis Worker's Compensation |
$710.62
|
|
|
SPLIT AGRFT FSNHFGMD GT 1ST 100 CM/</1%
|
Facility
|
OP
|
$2,603.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
20300118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$710.62 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,561.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$1,561.80
|
| Rate for Payer: Cash Price |
$1,561.80
|
| Rate for Payer: Cigna Commercial |
$2,212.55
|
| Rate for Payer: First Health Commercial |
$2,342.70
|
| Rate for Payer: First Health Workers Compensation |
$1,005.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,342.70
|
| Rate for Payer: GEHA Commercial |
$2,082.40
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,342.70
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$2,368.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,822.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,342.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,472.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,952.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,420.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$1,041.20
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$710.62
|
|
|
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 15120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,916.89 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: First Health Workers Compensation |
$4,473.92
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$3,163.38
|
|
|
SPNL PUNC THERA, FOR DRNG CSF - PF
|
Facility
|
IP
|
$272.64
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
20001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$74.43 |
| Max. Negotiated Rate |
$259.01 |
| Rate for Payer: Cash Price |
$163.58
|
| Rate for Payer: Cigna Commercial |
$231.74
|
| Rate for Payer: First Health Commercial |
$245.38
|
| Rate for Payer: First Health Workers Compensation |
$105.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$245.38
|
| Rate for Payer: GEHA Commercial |
$190.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$245.38
|
| Rate for Payer: Multiplan All |
$248.10
|
| Rate for Payer: OMNI Networks Commercial |
$190.85
|
| Rate for Payer: One Health Plan PPO/POS |
$245.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$259.01
|
| Rate for Payer: Three Rivers Provider Network All |
$204.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$253.56
|
| Rate for Payer: Zelis Auto |
$109.06
|
| Rate for Payer: Zelis Worker's Compensation |
$74.43
|
|
|
SPTUM INDUCTION
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4000220
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$386.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$195.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$193.13
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$193.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$212.44
|
| Rate for Payer: Humana Medicare Advantage |
$193.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$324.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$199.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$193.13
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.32
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$230.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$199.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$193.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$386.26
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.27
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$193.13
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$164.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.76
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
SPTUM INDUCTION
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4000220
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
SPUTUM COLLECTION
|
Facility
|
OP
|
$363.58
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
4000221
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$345.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cigna Commercial |
$309.04
|
| Rate for Payer: First Health Commercial |
$327.22
|
| Rate for Payer: First Health Workers Compensation |
$21.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.22
|
| Rate for Payer: GEHA Commercial |
$290.86
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.22
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$330.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$254.51
|
| Rate for Payer: One Health Plan PPO/POS |
$327.22
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$272.69
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$309.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$145.43
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$14.94
|
|
|
SPUTUM COLLECTION
|
Facility
|
IP
|
$363.58
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
4000221
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$345.40 |
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cigna Commercial |
$309.04
|
| Rate for Payer: First Health Commercial |
$327.22
|
| Rate for Payer: First Health Workers Compensation |
$21.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.22
|
| Rate for Payer: GEHA Commercial |
$254.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.22
|
| Rate for Payer: Multiplan All |
$330.86
|
| Rate for Payer: OMNI Networks Commercial |
$254.51
|
| Rate for Payer: One Health Plan PPO/POS |
$327.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.40
|
| Rate for Payer: Three Rivers Provider Network All |
$272.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.13
|
| Rate for Payer: Zelis Auto |
$145.43
|
| Rate for Payer: Zelis Worker's Compensation |
$14.94
|
|
|
SPY PHI KIT
|
Facility
|
IP
|
$2,570.72
|
|
|
Service Code
|
CPT C9733
|
| Hospital Charge Code |
7003532
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$701.81 |
| Max. Negotiated Rate |
$2,442.18 |
| Rate for Payer: Cash Price |
$1,542.43
|
| Rate for Payer: Cigna Commercial |
$2,185.11
|
| Rate for Payer: First Health Commercial |
$2,313.65
|
| Rate for Payer: First Health Workers Compensation |
$992.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,313.65
|
| Rate for Payer: GEHA Commercial |
$1,799.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,313.65
|
| Rate for Payer: Multiplan All |
$2,339.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,799.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,313.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,442.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,928.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,390.77
|
| Rate for Payer: Zelis Auto |
$1,028.29
|
| Rate for Payer: Zelis Worker's Compensation |
$701.81
|
|
|
SPY PHI KIT
|
Facility
|
OP
|
$2,570.72
|
|
|
Service Code
|
CPT C9733
|
| Hospital Charge Code |
7003532
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$184.03 |
| Max. Negotiated Rate |
$2,442.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,542.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$1,542.43
|
| Rate for Payer: Cash Price |
$1,542.43
|
| Rate for Payer: Cigna Commercial |
$2,185.11
|
| Rate for Payer: First Health Commercial |
$2,313.65
|
| Rate for Payer: First Health Workers Compensation |
$992.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,313.65
|
| Rate for Payer: GEHA Commercial |
$2,056.58
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,313.65
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$187.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$2,339.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,799.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,313.65
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$216.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$187.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,442.18
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,928.04
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$187.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,390.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,028.29
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$701.81
|
|
|
SRA UNFRACTIONATED HEPARIN PLT AB POP
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2299506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$40.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$292.80
|
| Rate for Payer: GEHA Medicare |
$18.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Humana ChoiceCare |
$20.21
|
| Rate for Payer: Humana Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.37
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.23
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.74
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$311.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.37
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Medicare |
$15.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.04
|
| Rate for Payer: Zelis Worker's Compensation |
$28.62
|
|
|
SRA UNFRACTIONATED HEPARIN PLT AB POP
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2299506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$40.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$256.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.62
|
|
|
SRS CRANIAL LESION COMPLEX
|
Facility
|
IP
|
$2,980.00
|
|
|
Service Code
|
CPT 61798
|
| Hospital Charge Code |
6161798
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$813.54 |
| Max. Negotiated Rate |
$2,831.00 |
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cigna Commercial |
$2,533.00
|
| Rate for Payer: First Health Commercial |
$2,682.00
|
| Rate for Payer: First Health Workers Compensation |
$1,150.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,682.00
|
| Rate for Payer: GEHA Commercial |
$2,086.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,682.00
|
| Rate for Payer: Multiplan All |
$2,711.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,086.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,682.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,831.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,235.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,771.40
|
| Rate for Payer: Zelis Auto |
$1,192.00
|
| Rate for Payer: Zelis Worker's Compensation |
$813.54
|
|
|
SRS CRANIAL LESION COMPLEX
|
Facility
|
OP
|
$2,980.00
|
|
|
Service Code
|
CPT 61798
|
| Hospital Charge Code |
6161798
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$2,831.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cigna Commercial |
$2,533.00
|
| Rate for Payer: First Health Commercial |
$2,682.00
|
| Rate for Payer: First Health Workers Compensation |
$1,150.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,682.00
|
| Rate for Payer: GEHA Commercial |
$2,384.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,682.00
|
| Rate for Payer: Humana ChoiceCare |
$774.80
|
| Rate for Payer: Multiplan All |
$2,711.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,788.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,086.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,682.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,831.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,235.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,622.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$745.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,771.40
|
| Rate for Payer: Zelis Auto |
$1,192.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,490.00
|
| Rate for Payer: Zelis Worker's Compensation |
$813.54
|
|
|
SRS CRANIAL LESION SIMPLE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT 61796
|
| Hospital Charge Code |
6161796
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$594.59 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna Commercial |
$1,851.30
|
| Rate for Payer: First Health Commercial |
$1,960.20
|
| Rate for Payer: First Health Workers Compensation |
$840.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,960.20
|
| Rate for Payer: GEHA Commercial |
$1,524.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,960.20
|
| Rate for Payer: Multiplan All |
$1,981.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,524.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,960.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,069.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,633.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,025.54
|
| Rate for Payer: Zelis Auto |
$871.20
|
| Rate for Payer: Zelis Worker's Compensation |
$594.59
|
|
|
SRS CRANIAL LESION SIMPLE
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT 61796
|
| Hospital Charge Code |
6161796
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$544.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna Commercial |
$1,851.30
|
| Rate for Payer: First Health Commercial |
$1,960.20
|
| Rate for Payer: First Health Workers Compensation |
$840.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,960.20
|
| Rate for Payer: GEHA Commercial |
$1,742.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,960.20
|
| Rate for Payer: Humana ChoiceCare |
$566.28
|
| Rate for Payer: Multiplan All |
$1,981.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,306.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,524.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,960.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,069.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,633.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,916.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$544.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,025.54
|
| Rate for Payer: Zelis Auto |
$871.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,089.00
|
| Rate for Payer: Zelis Worker's Compensation |
$594.59
|
|
|
SRS CRAN LES COMPLEX ADDL
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
CPT 61799
|
| Hospital Charge Code |
6161799
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$789.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$498.60
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$706.35
|
| Rate for Payer: First Health Commercial |
$747.90
|
| Rate for Payer: First Health Workers Compensation |
$320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.90
|
| Rate for Payer: GEHA Commercial |
$664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.90
|
| Rate for Payer: Humana ChoiceCare |
$216.06
|
| Rate for Payer: Multiplan All |
$756.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$498.60
|
| Rate for Payer: OMNI Networks Commercial |
$581.70
|
| Rate for Payer: One Health Plan PPO/POS |
$747.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$789.45
|
| Rate for Payer: Three Rivers Provider Network All |
$623.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$731.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$772.83
|
| Rate for Payer: Zelis Auto |
$332.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.50
|
| Rate for Payer: Zelis Worker's Compensation |
$226.86
|
|
|
SRS CRAN LES COMPLEX ADDL
|
Facility
|
IP
|
$831.00
|
|
|
Service Code
|
CPT 61799
|
| Hospital Charge Code |
6161799
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.86 |
| Max. Negotiated Rate |
$789.45 |
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$706.35
|
| Rate for Payer: First Health Commercial |
$747.90
|
| Rate for Payer: First Health Workers Compensation |
$320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.90
|
| Rate for Payer: GEHA Commercial |
$581.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.90
|
| Rate for Payer: Multiplan All |
$756.21
|
| Rate for Payer: OMNI Networks Commercial |
$581.70
|
| Rate for Payer: One Health Plan PPO/POS |
$747.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$789.45
|
| Rate for Payer: Three Rivers Provider Network All |
$623.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$772.83
|
| Rate for Payer: Zelis Auto |
$332.40
|
| Rate for Payer: Zelis Worker's Compensation |
$226.86
|
|
|
SRS CRAN LES SIMPLE ADDL
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 61797
|
| Hospital Charge Code |
6161797
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: First Health Workers Compensation |
$233.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Worker's Compensation |
$164.89
|
|
