|
SURGICAL EXPOSURE PROSTATE
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 55860
|
| Hospital Charge Code |
6155860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.04 |
| Max. Negotiated Rate |
$1,715.70 |
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna Commercial |
$1,535.10
|
| Rate for Payer: First Health Commercial |
$1,625.40
|
| Rate for Payer: First Health Workers Compensation |
$697.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,625.40
|
| Rate for Payer: GEHA Commercial |
$1,264.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,625.40
|
| Rate for Payer: Multiplan All |
$1,643.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,625.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,715.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,354.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,679.58
|
| Rate for Payer: Zelis Auto |
$722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$493.04
|
|
|
SURGICAL EXPOSURE PROSTATE
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 55860
|
| Hospital Charge Code |
6155860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.04 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,083.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,603.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna Commercial |
$1,535.10
|
| Rate for Payer: First Health Commercial |
$1,625.40
|
| Rate for Payer: First Health Workers Compensation |
$697.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,625.40
|
| Rate for Payer: GEHA Commercial |
$1,444.80
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,625.40
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,636.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,643.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,625.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,889.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,636.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,715.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,354.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,636.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,679.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$722.40
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$493.04
|
|
|
SURGICAL OPENING, ESOPHAGUS
|
Facility
|
OP
|
$2,715.00
|
|
|
Service Code
|
CPT 43351
|
| Hospital Charge Code |
6143351
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$678.75 |
| Max. Negotiated Rate |
$2,579.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,629.00
|
| Rate for Payer: Cash Price |
$1,629.00
|
| Rate for Payer: Cigna Commercial |
$2,307.75
|
| Rate for Payer: First Health Commercial |
$2,443.50
|
| Rate for Payer: First Health Workers Compensation |
$1,048.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,443.50
|
| Rate for Payer: GEHA Commercial |
$2,172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,443.50
|
| Rate for Payer: Humana ChoiceCare |
$705.90
|
| Rate for Payer: Multiplan All |
$2,470.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,629.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,900.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,443.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,579.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,036.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,389.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$678.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,524.95
|
| Rate for Payer: Zelis Auto |
$1,086.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,357.50
|
| Rate for Payer: Zelis Worker's Compensation |
$741.20
|
|
|
SURGICAL OPENING, ESOPHAGUS
|
Facility
|
OP
|
$2,258.00
|
|
|
Service Code
|
CPT 43352
|
| Hospital Charge Code |
6143352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$564.50 |
| Max. Negotiated Rate |
$2,145.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,354.80
|
| Rate for Payer: Cash Price |
$1,354.80
|
| Rate for Payer: Cigna Commercial |
$1,919.30
|
| Rate for Payer: First Health Commercial |
$2,032.20
|
| Rate for Payer: First Health Workers Compensation |
$871.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,032.20
|
| Rate for Payer: GEHA Commercial |
$1,806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,032.20
|
| Rate for Payer: Humana ChoiceCare |
$587.08
|
| Rate for Payer: Multiplan All |
$2,054.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,354.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,580.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,032.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,145.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,693.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,987.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$564.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,099.94
|
| Rate for Payer: Zelis Auto |
$903.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,129.00
|
| Rate for Payer: Zelis Worker's Compensation |
$616.43
|
|
|
SURGICAL OPENING, ESOPHAGUS
|
Facility
|
IP
|
$2,258.00
|
|
|
Service Code
|
CPT 43352
|
| Hospital Charge Code |
6143352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$616.43 |
| Max. Negotiated Rate |
$2,145.10 |
| Rate for Payer: Cash Price |
$1,354.80
|
| Rate for Payer: Cigna Commercial |
$1,919.30
|
| Rate for Payer: First Health Commercial |
$2,032.20
|
| Rate for Payer: First Health Workers Compensation |
$871.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,032.20
|
| Rate for Payer: GEHA Commercial |
$1,580.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,032.20
|
| Rate for Payer: Multiplan All |
$2,054.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,580.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,032.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,145.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,693.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,099.94
|
| Rate for Payer: Zelis Auto |
$903.20
|
| Rate for Payer: Zelis Worker's Compensation |
$616.43
|
|
|
SURGICAL OPENING, ESOPHAGUS
|
Facility
|
IP
|
$2,715.00
|
|
|
Service Code
|
CPT 43351
|
| Hospital Charge Code |
6143351
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$741.20 |
| Max. Negotiated Rate |
$2,579.25 |
| Rate for Payer: Cash Price |
$1,629.00
|
| Rate for Payer: Cigna Commercial |
$2,307.75
|
| Rate for Payer: First Health Commercial |
$2,443.50
|
| Rate for Payer: First Health Workers Compensation |
$1,048.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,443.50
|
| Rate for Payer: GEHA Commercial |
$1,900.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,443.50
|
| Rate for Payer: Multiplan All |
$2,470.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,900.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,443.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,579.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,036.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,524.95
|
| Rate for Payer: Zelis Auto |
$1,086.00
|
| Rate for Payer: Zelis Worker's Compensation |
$741.20
|
|
|
SURGICAL OPENING OF STOMACH
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 43510
|
| Hospital Charge Code |
6143510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$540.54 |
| Max. Negotiated Rate |
$1,881.00 |
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cigna Commercial |
$1,683.00
|
| Rate for Payer: First Health Commercial |
$1,782.00
|
| Rate for Payer: First Health Workers Compensation |
$764.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,782.00
|
| Rate for Payer: GEHA Commercial |
$1,386.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,782.00
|
| Rate for Payer: Multiplan All |
$1,801.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,386.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,782.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,881.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,485.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,841.40
|
| Rate for Payer: Zelis Auto |
$792.00
|
| Rate for Payer: Zelis Worker's Compensation |
$540.54
|
|
|
SURGICAL OPENING OF STOMACH
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 43510
|
| Hospital Charge Code |
6143510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$540.54 |
| Max. Negotiated Rate |
$1,881.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,188.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cigna Commercial |
$1,683.00
|
| Rate for Payer: First Health Commercial |
$1,782.00
|
| Rate for Payer: First Health Workers Compensation |
$764.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,782.00
|
| Rate for Payer: GEHA Commercial |
$1,584.00
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,782.00
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$1,801.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,386.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,782.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,881.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,485.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,841.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$792.00
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$540.54
|
|
|
SURGICAL OPENING OF STOMACH
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 43500
|
| Hospital Charge Code |
6143500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$448.81 |
| Max. Negotiated Rate |
$1,561.80 |
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna Commercial |
$1,397.40
|
| Rate for Payer: First Health Commercial |
$1,479.60
|
| Rate for Payer: First Health Workers Compensation |
$634.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,479.60
|
| Rate for Payer: GEHA Commercial |
$1,150.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,479.60
|
| Rate for Payer: Multiplan All |
$1,496.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,479.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,561.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,528.92
|
| Rate for Payer: Zelis Auto |
$657.60
|
| Rate for Payer: Zelis Worker's Compensation |
$448.81
|
|
|
SURGICAL OPENING OF STOMACH
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 43500
|
| Hospital Charge Code |
6143500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$411.00 |
| Max. Negotiated Rate |
$1,561.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna Commercial |
$1,397.40
|
| Rate for Payer: First Health Commercial |
$1,479.60
|
| Rate for Payer: First Health Workers Compensation |
$634.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,479.60
|
| Rate for Payer: GEHA Commercial |
$1,315.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,479.60
|
| Rate for Payer: Humana ChoiceCare |
$427.44
|
| Rate for Payer: Multiplan All |
$1,496.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$986.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,479.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,561.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,446.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,528.92
|
| Rate for Payer: Zelis Auto |
$657.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$822.00
|
| Rate for Payer: Zelis Worker's Compensation |
$448.81
|
|
|
SURGICAL OPENING OF THROAT
|
Facility
|
IP
|
$1,587.00
|
|
|
Service Code
|
CPT 42955
|
| Hospital Charge Code |
6142955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.25 |
| Max. Negotiated Rate |
$1,507.65 |
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$1,348.95
|
| Rate for Payer: First Health Commercial |
$1,428.30
|
| Rate for Payer: First Health Workers Compensation |
$612.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,428.30
|
| Rate for Payer: GEHA Commercial |
$1,110.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,428.30
|
| Rate for Payer: Multiplan All |
$1,444.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,428.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,507.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,190.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,475.91
|
| Rate for Payer: Zelis Auto |
$634.80
|
| Rate for Payer: Zelis Worker's Compensation |
$433.25
|
|
|
SURGICAL OPENING OF THROAT
|
Facility
|
OP
|
$1,587.00
|
|
|
Service Code
|
CPT 42955
|
| Hospital Charge Code |
6142955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.25 |
| Max. Negotiated Rate |
$2,813.06 |
| 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 |
$952.20
|
| 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 |
$1,406.53
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$1,348.95
|
| Rate for Payer: First Health Commercial |
$1,428.30
|
| Rate for Payer: First Health Workers Compensation |
$612.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,428.30
|
| Rate for Payer: GEHA Commercial |
$1,269.60
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,428.30
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,444.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,428.30
|
| 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 |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,507.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,190.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,475.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$634.80
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$433.25
|
|
|
SURGICAL PATH,PROSTATE NEEDLE BX, ANY ME
|
Facility
|
OP
|
$1,890.35
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
8900416
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$290.33 |
| Max. Negotiated Rate |
$1,795.83 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,134.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$341.57
|
| Rate for Payer: Cash Price |
$1,134.21
|
| Rate for Payer: Cash Price |
$1,134.21
|
| Rate for Payer: Cigna Commercial |
$1,606.80
|
| Rate for Payer: First Health Commercial |
$1,701.32
|
| Rate for Payer: First Health Workers Compensation |
$729.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,701.32
|
| Rate for Payer: GEHA Commercial |
$1,512.28
|
| Rate for Payer: GEHA Medicare |
$341.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,701.32
|
| Rate for Payer: Humana ChoiceCare |
$375.73
|
| Rate for Payer: Humana Medicare Advantage |
$341.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$573.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$341.57
|
| Rate for Payer: Multiplan All |
$1,720.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$580.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,323.24
|
| Rate for Payer: One Health Plan PPO/POS |
$1,701.32
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$341.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,795.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$683.14
|
| Rate for Payer: Three Rivers Provider Network All |
$1,417.76
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.74
|
| Rate for Payer: United Healthcare Commercial |
$1,606.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,758.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$341.57
|
| Rate for Payer: Zelis Auto |
$756.14
|
| Rate for Payer: Zelis Medicare |
$290.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$409.88
|
| Rate for Payer: Zelis Worker's Compensation |
$516.07
|
|
|
SURGICAL PATH,PROSTATE NEEDLE BX, ANY ME
|
Facility
|
IP
|
$1,890.35
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
8900416
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$516.07 |
| Max. Negotiated Rate |
$1,795.83 |
| Rate for Payer: Cash Price |
$1,134.21
|
| Rate for Payer: Cigna Commercial |
$1,606.80
|
| Rate for Payer: First Health Commercial |
$1,701.32
|
| Rate for Payer: First Health Workers Compensation |
$729.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,701.32
|
| Rate for Payer: GEHA Commercial |
$1,323.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,701.32
|
| Rate for Payer: Multiplan All |
$1,720.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,323.24
|
| Rate for Payer: One Health Plan PPO/POS |
$1,701.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,795.83
|
| Rate for Payer: Three Rivers Provider Network All |
$1,417.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,758.03
|
| Rate for Payer: Zelis Auto |
$756.14
|
| Rate for Payer: Zelis Worker's Compensation |
$516.07
|
|
|
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR 1% OF BODY AREA OF INFANTS AND CHILDREN
|
Facility
|
OP
|
$1,162.48
|
|
|
Service Code
|
CPT 15004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: First Health Workers Compensation |
$748.06
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$528.93
|
|
|
SURGICAL REPAIR OF STOMACH
|
Facility
|
IP
|
$3,210.00
|
|
|
Service Code
|
CPT 43502
|
| Hospital Charge Code |
6143502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$876.33 |
| Max. Negotiated Rate |
$3,049.50 |
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cigna Commercial |
$2,728.50
|
| Rate for Payer: First Health Commercial |
$2,889.00
|
| Rate for Payer: First Health Workers Compensation |
$1,239.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,889.00
|
| Rate for Payer: GEHA Commercial |
$2,247.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,889.00
|
| Rate for Payer: Multiplan All |
$2,921.10
|
| Rate for Payer: OMNI Networks Commercial |
$2,247.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,889.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,049.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,407.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,985.30
|
| Rate for Payer: Zelis Auto |
$1,284.00
|
| Rate for Payer: Zelis Worker's Compensation |
$876.33
|
|
|
SURGICAL REPAIR OF STOMACH
|
Facility
|
IP
|
$2,833.00
|
|
|
Service Code
|
CPT 43501
|
| Hospital Charge Code |
6143501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$773.41 |
| Max. Negotiated Rate |
$2,691.35 |
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Cigna Commercial |
$2,408.05
|
| Rate for Payer: First Health Commercial |
$2,549.70
|
| Rate for Payer: First Health Workers Compensation |
$1,093.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,549.70
|
| Rate for Payer: GEHA Commercial |
$1,983.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,549.70
|
| Rate for Payer: Multiplan All |
$2,578.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,983.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,549.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,691.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,124.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,634.69
|
| Rate for Payer: Zelis Auto |
$1,133.20
|
| Rate for Payer: Zelis Worker's Compensation |
$773.41
|
|
|
SURGICAL REPAIR OF STOMACH
|
Facility
|
OP
|
$3,210.00
|
|
|
Service Code
|
CPT 43502
|
| Hospital Charge Code |
6143502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$3,049.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,926.00
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cigna Commercial |
$2,728.50
|
| Rate for Payer: First Health Commercial |
$2,889.00
|
| Rate for Payer: First Health Workers Compensation |
$1,239.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,889.00
|
| Rate for Payer: GEHA Commercial |
$2,568.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,889.00
|
| Rate for Payer: Humana ChoiceCare |
$834.60
|
| Rate for Payer: Multiplan All |
$2,921.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,926.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,247.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,889.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,049.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,407.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,824.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$802.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,985.30
|
| Rate for Payer: Zelis Auto |
$1,284.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,605.00
|
| Rate for Payer: Zelis Worker's Compensation |
$876.33
|
|
|
SURGICAL REPAIR OF STOMACH
|
Facility
|
OP
|
$2,833.00
|
|
|
Service Code
|
CPT 43501
|
| Hospital Charge Code |
6143501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$708.25 |
| Max. Negotiated Rate |
$2,691.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,699.80
|
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Cigna Commercial |
$2,408.05
|
| Rate for Payer: First Health Commercial |
$2,549.70
|
| Rate for Payer: First Health Workers Compensation |
$1,093.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,549.70
|
| Rate for Payer: GEHA Commercial |
$2,266.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,549.70
|
| Rate for Payer: Humana ChoiceCare |
$736.58
|
| Rate for Payer: Multiplan All |
$2,578.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,699.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,983.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,549.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,691.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,124.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,493.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$708.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,634.69
|
| Rate for Payer: Zelis Auto |
$1,133.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,416.50
|
| Rate for Payer: Zelis Worker's Compensation |
$773.41
|
|
|
SURGICAL REVISION INTESTINE
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 44680
|
| Hospital Charge Code |
6144680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$2,131.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna Commercial |
$1,907.40
|
| Rate for Payer: First Health Commercial |
$2,019.60
|
| Rate for Payer: First Health Workers Compensation |
$866.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,019.60
|
| Rate for Payer: GEHA Commercial |
$1,795.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,019.60
|
| Rate for Payer: Humana ChoiceCare |
$583.44
|
| Rate for Payer: Multiplan All |
$2,042.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,346.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,019.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,131.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,683.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,974.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$561.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,086.92
|
| Rate for Payer: Zelis Auto |
$897.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$612.61
|
|
|
SURGICAL REVISION INTESTINE
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 44680
|
| Hospital Charge Code |
6144680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$612.61 |
| Max. Negotiated Rate |
$2,131.80 |
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna Commercial |
$1,907.40
|
| Rate for Payer: First Health Commercial |
$2,019.60
|
| Rate for Payer: First Health Workers Compensation |
$866.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,019.60
|
| Rate for Payer: GEHA Commercial |
$1,570.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,019.60
|
| Rate for Payer: Multiplan All |
$2,042.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,019.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,131.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,683.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,086.92
|
| Rate for Payer: Zelis Auto |
$897.60
|
| Rate for Payer: Zelis Worker's Compensation |
$612.61
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC
|
Facility
|
OP
|
$5,208.02
|
|
|
Service Code
|
CPT 46275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,919.98 |
| 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 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: First Health Workers Compensation |
$3,351.36
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| 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: New Mexico Health Connections Medicare |
$4,426.82
|
| 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 Worker's Compensation |
$5,208.02
|
| 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: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| 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 |
$2,369.65
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
|
Facility
|
OP
|
$5,208.02
|
|
|
Service Code
|
CPT 46270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,919.98 |
| 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 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: First Health Workers Compensation |
$3,351.36
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| 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: New Mexico Health Connections Medicare |
$4,426.82
|
| 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 Worker's Compensation |
$5,208.02
|
| 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: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| 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 |
$2,369.65
|
|
|
SURGIDAC
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$399.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| Rate for Payer: Multiplan All |
$518.70
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$541.50
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.10
|
| Rate for Payer: Zelis Auto |
$228.00
|
|
|
SURGIDAC
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$456.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| Rate for Payer: Humana ChoiceCare |
$148.20
|
| Rate for Payer: Multiplan All |
$518.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.00
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$541.50
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$501.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.10
|
| Rate for Payer: Zelis Auto |
$228.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.00
|
|
