|
sulfonylurea analysis REF814133
|
Facility
|
IP
|
$421.73
|
|
|
Service Code
|
CPT 80377
|
| Hospital Charge Code |
2200847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$400.64 |
| Rate for Payer: Cash Price |
$253.04
|
| Rate for Payer: Cash Price |
$253.04
|
| Rate for Payer: Cigna Commercial |
$358.47
|
| Rate for Payer: First Health Commercial |
$379.56
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$379.56
|
| Rate for Payer: GEHA Commercial |
$295.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$379.56
|
| Rate for Payer: Multiplan All |
$383.77
|
| Rate for Payer: OMNI Networks Commercial |
$295.21
|
| Rate for Payer: One Health Plan PPO/POS |
$379.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$400.64
|
| Rate for Payer: Three Rivers Provider Network All |
$316.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$392.21
|
| Rate for Payer: Zelis Auto |
$168.69
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
sulfonylurea analysis REF814133
|
Facility
|
OP
|
$421.73
|
|
|
Service Code
|
CPT 80377
|
| Hospital Charge Code |
2200847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$400.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$253.04
|
| Rate for Payer: Cash Price |
$253.04
|
| Rate for Payer: Cash Price |
$253.04
|
| Rate for Payer: Cigna Commercial |
$358.47
|
| Rate for Payer: First Health Commercial |
$379.56
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$379.56
|
| Rate for Payer: GEHA Commercial |
$337.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$379.56
|
| Rate for Payer: Humana ChoiceCare |
$109.65
|
| Rate for Payer: Multiplan All |
$383.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$253.04
|
| Rate for Payer: OMNI Networks Commercial |
$295.21
|
| Rate for Payer: One Health Plan PPO/POS |
$379.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$400.64
|
| Rate for Payer: Three Rivers Provider Network All |
$316.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.12
|
| Rate for Payer: United Healthcare Commercial |
$358.47
|
| Rate for Payer: United Healthcare Managed Medicaid |
$105.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$392.21
|
| Rate for Payer: Zelis Auto |
$168.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$210.87
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
SUMAtriptan SUCCINATE 6MG/0.5ML
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT J3030
|
| Hospital Charge Code |
3300870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$51.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
SUMAtriptan SUCCINATE 6MG/0.5ML
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT J3030
|
| Hospital Charge Code |
3300870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$58.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Humana ChoiceCare |
$18.98
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.80
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$64.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$36.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
SUPRACERVICAL ABDOMINAL HYSTERECTOMY (SUBTOTAL HYSTERECTOMY), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S)
|
Facility
|
OP
|
$2,939.73
|
|
|
Service Code
|
CPT 58180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,078.59 |
| Max. Negotiated Rate |
$2,939.73 |
| Rate for Payer: First Health Workers Compensation |
$2,939.73
|
| Rate for Payer: Zelis Worker's Compensation |
$2,078.59
|
|
|
SURETAPE FIBERLINK 1.3MM
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$646.00
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.00
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.00
|
| Rate for Payer: Multiplan All |
$691.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.00
|
| Rate for Payer: One Health Plan PPO/POS |
$684.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.00
|
| Rate for Payer: Three Rivers Provider Network All |
$570.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$706.80
|
| Rate for Payer: Zelis Auto |
$304.00
|
|
|
SURETAPE FIBERLINK 1.3MM
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$646.00
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.00
|
| Rate for Payer: GEHA Commercial |
$608.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.00
|
| Rate for Payer: Humana ChoiceCare |
$197.60
|
| Rate for Payer: Multiplan All |
$691.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$456.00
|
| Rate for Payer: OMNI Networks Commercial |
$532.00
|
| Rate for Payer: One Health Plan PPO/POS |
$684.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.00
|
| Rate for Payer: Three Rivers Provider Network All |
$570.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$706.80
|
| Rate for Payer: Zelis Auto |
$304.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$380.00
|
|
|
SURG DX EXAM ANORECTAL
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
6145990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$202.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: First Health Workers Compensation |
$130.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$269.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$134.80
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$92.00
|
|
|
SURG DX EXAM ANORECTAL
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
6145990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: First Health Workers Compensation |
$130.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$235.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: Zelis Auto |
$134.80
|
| Rate for Payer: Zelis Worker's Compensation |
$92.00
|
|
|
SURGERY FOR URETHRA POUCH
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT 53240
|
| Hospital Charge Code |
6153240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.42 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$745.45
|
| Rate for Payer: First Health Commercial |
$789.30
|
| Rate for Payer: First Health Workers Compensation |
$338.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$789.30
|
| Rate for Payer: GEHA Commercial |
$701.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$789.30
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$798.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$613.90
|
| Rate for Payer: One Health Plan PPO/POS |
$789.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$833.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$657.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$815.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$350.80
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$239.42
|
|
|
SURGERY FOR URETHRA POUCH
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT 53240
|
| Hospital Charge Code |
6153240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.42 |
| Max. Negotiated Rate |
$833.15 |
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$745.45
|
| Rate for Payer: First Health Commercial |
$789.30
|
| Rate for Payer: First Health Workers Compensation |
$338.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$789.30
|
| Rate for Payer: GEHA Commercial |
$613.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$789.30
|
| Rate for Payer: Multiplan All |
$798.07
|
| Rate for Payer: OMNI Networks Commercial |
$613.90
|
| Rate for Payer: One Health Plan PPO/POS |
$789.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$833.15
|
| Rate for Payer: Three Rivers Provider Network All |
$657.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$815.61
|
| Rate for Payer: Zelis Auto |
$350.80
|
| Rate for Payer: Zelis Worker's Compensation |
$239.42
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
6156440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.97 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$470.05
|
| Rate for Payer: First Health Commercial |
$497.70
|
| Rate for Payer: First Health Workers Compensation |
$213.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$497.70
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$497.70
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$503.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$387.10
|
| Rate for Payer: One Health Plan PPO/POS |
$497.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$525.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$414.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$514.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$221.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$150.97
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
6156440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.97 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$470.05
|
| Rate for Payer: First Health Commercial |
$497.70
|
| Rate for Payer: First Health Workers Compensation |
$213.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$497.70
|
| Rate for Payer: GEHA Commercial |
$387.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$497.70
|
| Rate for Payer: Multiplan All |
$503.23
|
| Rate for Payer: OMNI Networks Commercial |
$387.10
|
| Rate for Payer: One Health Plan PPO/POS |
$497.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$525.35
|
| Rate for Payer: Three Rivers Provider Network All |
$414.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$514.29
|
| Rate for Payer: Zelis Auto |
$221.20
|
| Rate for Payer: Zelis Worker's Compensation |
$150.97
|
|
|
SURGERY OF PANCREATIC CYST
|
Facility
|
IP
|
$2,354.00
|
|
|
Service Code
|
CPT 48500
|
| Hospital Charge Code |
6148500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$642.64 |
| Max. Negotiated Rate |
$2,236.30 |
| Rate for Payer: Cash Price |
$1,412.40
|
| Rate for Payer: Cigna Commercial |
$2,000.90
|
| Rate for Payer: First Health Commercial |
$2,118.60
|
| Rate for Payer: First Health Workers Compensation |
$908.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,118.60
|
| Rate for Payer: GEHA Commercial |
$1,647.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,118.60
|
| Rate for Payer: Multiplan All |
$2,142.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,647.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,118.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,236.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,765.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,189.22
|
| Rate for Payer: Zelis Auto |
$941.60
|
| Rate for Payer: Zelis Worker's Compensation |
$642.64
|
|
|
SURGERY OF PANCREATIC CYST
|
Facility
|
OP
|
$2,354.00
|
|
|
Service Code
|
CPT 48500
|
| Hospital Charge Code |
6148500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$588.50 |
| Max. Negotiated Rate |
$2,236.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,412.40
|
| Rate for Payer: Cash Price |
$1,412.40
|
| Rate for Payer: Cigna Commercial |
$2,000.90
|
| Rate for Payer: First Health Commercial |
$2,118.60
|
| Rate for Payer: First Health Workers Compensation |
$908.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,118.60
|
| Rate for Payer: GEHA Commercial |
$1,883.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,118.60
|
| Rate for Payer: Humana ChoiceCare |
$612.04
|
| Rate for Payer: Multiplan All |
$2,142.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,412.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,647.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,118.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,236.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,765.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,071.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,189.22
|
| Rate for Payer: Zelis Auto |
$941.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,177.00
|
| Rate for Payer: Zelis Worker's Compensation |
$642.64
|
|
|
SURGERY/SPEECH PROSTHESIS
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 31611
|
| Hospital Charge Code |
6131611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Worker's Compensation |
$297.02
|
|
|
SURGERY/SPEECH PROSTHESIS
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 31611
|
| Hospital Charge Code |
6131611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$870.40
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$297.02
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT 27485
|
| Hospital Charge Code |
6127485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.10 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,593.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$824.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,593.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,846.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$530.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$1,099.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,904.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,353.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,904.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,904.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$375.10
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
CPT 27479
|
| Hospital Charge Code |
6127479
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$443.62 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,381.25
|
| Rate for Payer: First Health Commercial |
$1,462.50
|
| Rate for Payer: First Health Workers Compensation |
$627.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,462.50
|
| Rate for Payer: GEHA Commercial |
$1,300.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,462.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,478.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,137.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,462.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,543.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,511.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$650.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$443.62
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 27485
|
| Hospital Charge Code |
6127485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.10 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$530.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$961.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Worker's Compensation |
$375.10
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT 27479
|
| Hospital Charge Code |
6127479
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$443.62 |
| Max. Negotiated Rate |
$1,543.75 |
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,381.25
|
| Rate for Payer: First Health Commercial |
$1,462.50
|
| Rate for Payer: First Health Workers Compensation |
$627.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,462.50
|
| Rate for Payer: GEHA Commercial |
$1,137.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,462.50
|
| Rate for Payer: Multiplan All |
$1,478.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,137.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,462.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,543.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,511.25
|
| Rate for Payer: Zelis Auto |
$650.00
|
| Rate for Payer: Zelis Worker's Compensation |
$443.62
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
6127477
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: First Health Commercial |
$1,350.00
|
| Rate for Payer: First Health Workers Compensation |
$579.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.00
|
| Rate for Payer: GEHA Commercial |
$1,200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.00
|
| Rate for Payer: Humana ChoiceCare |
$390.00
|
| Rate for Payer: Multiplan All |
$1,365.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$900.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,320.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.00
|
| Rate for Payer: Zelis Auto |
$600.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$750.00
|
| Rate for Payer: Zelis Worker's Compensation |
$409.50
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
6127477
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: First Health Commercial |
$1,350.00
|
| Rate for Payer: First Health Workers Compensation |
$579.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.00
|
| Rate for Payer: GEHA Commercial |
$1,050.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.00
|
| Rate for Payer: Multiplan All |
$1,365.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.00
|
| Rate for Payer: Zelis Auto |
$600.00
|
| Rate for Payer: Zelis Worker's Compensation |
$409.50
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
CPT 27475
|
| Hospital Charge Code |
6127475
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.19 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$813.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$1,152.60
|
| Rate for Payer: First Health Commercial |
$1,220.40
|
| Rate for Payer: First Health Workers Compensation |
$523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,220.40
|
| Rate for Payer: GEHA Commercial |
$1,084.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,220.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,233.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$949.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,220.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,288.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,017.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,261.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$542.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$370.19
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
CPT 27475
|
| Hospital Charge Code |
6127475
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.19 |
| Max. Negotiated Rate |
$1,288.20 |
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$1,152.60
|
| Rate for Payer: First Health Commercial |
$1,220.40
|
| Rate for Payer: First Health Workers Compensation |
$523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,220.40
|
| Rate for Payer: GEHA Commercial |
$949.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,220.40
|
| Rate for Payer: Multiplan All |
$1,233.96
|
| Rate for Payer: OMNI Networks Commercial |
$949.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,220.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,288.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,017.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,261.08
|
| Rate for Payer: Zelis Auto |
$542.40
|
| Rate for Payer: Zelis Worker's Compensation |
$370.19
|
|
