|
SURG PATH LEV I
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
2299039
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$23.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.86
|
|
|
SURG PATH LEV I
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
2299039
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$23.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$16.86
|
|
|
SURG PAT LEV II
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
2299040
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$37.27
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$51.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$166.40
|
| Rate for Payer: GEHA Medicare |
$37.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Humana ChoiceCare |
$41.00
|
| Rate for Payer: Humana Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$62.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$37.27
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.36
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$37.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$74.54
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.52
|
| Rate for Payer: United Healthcare Commercial |
$176.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.27
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Medicare |
$31.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.72
|
| Rate for Payer: Zelis Worker's Compensation |
$36.50
|
|
|
SURG PAT LEV II
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
2299040
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$51.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Worker's Compensation |
$36.50
|
|
|
SURG PAT LEV III
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
2299041
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$64.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$45.37
|
|
|
SURG PAT LEV III
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
2299041
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$41.10 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$50.73
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$64.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: GEHA Medicare |
$50.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$55.80
|
| Rate for Payer: Humana Medicare Advantage |
$50.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$85.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$50.73
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.24
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$48.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$50.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$101.46
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.72
|
| Rate for Payer: United Healthcare Commercial |
$237.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$50.73
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Medicare |
$43.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.88
|
| Rate for Payer: Zelis Worker's Compensation |
$45.37
|
|
|
SURG PAT LEV IV
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
2299042
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: First Health Workers Compensation |
$103.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$256.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: Zelis Auto |
$146.80
|
| Rate for Payer: Zelis Worker's Compensation |
$73.01
|
|
|
SURG PAT LEV IV
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
2299042
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$50.73
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: First Health Workers Compensation |
$103.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$293.60
|
| Rate for Payer: GEHA Medicare |
$50.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Humana ChoiceCare |
$55.80
|
| Rate for Payer: Humana Medicare Advantage |
$50.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$85.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$50.73
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.24
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$53.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$50.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$101.46
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.72
|
| Rate for Payer: United Healthcare Commercial |
$311.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$50.73
|
| Rate for Payer: Zelis Auto |
$146.80
|
| Rate for Payer: Zelis Medicare |
$43.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.88
|
| Rate for Payer: Zelis Worker's Compensation |
$73.01
|
|
|
SURG PAT LEV V
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
2299043
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$683.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$344.52
|
| 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 |
$344.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$272.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$341.57
|
| 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 |
$330.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$497.70
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: GEHA Medicare |
$341.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$497.70
|
| 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 |
$278.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$341.57
|
| Rate for Payer: Multiplan All |
$503.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$580.67
|
| 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 |
$321.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$278.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$341.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$525.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$683.14
|
| Rate for Payer: Three Rivers Provider Network All |
$414.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.74
|
| Rate for Payer: United Healthcare Commercial |
$470.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$514.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$341.57
|
| Rate for Payer: Zelis Auto |
$221.20
|
| Rate for Payer: Zelis Medicare |
$290.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$409.88
|
| Rate for Payer: Zelis Worker's Compensation |
$233.78
|
|
|
SURG PAT LEV V
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
2299043
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$525.35 |
| 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 |
$330.63
|
| 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 |
$233.78
|
|
|
SURG PAT LEV VI
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
2299044
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$708.70 |
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: First Health Workers Compensation |
$499.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$522.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: Zelis Auto |
$298.40
|
| Rate for Payer: Zelis Worker's Compensation |
$353.39
|
|
|
SURG PAT LEV VI
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
2299044
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$1,551.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$405.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$447.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$405.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$321.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$775.68
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: First Health Workers Compensation |
$499.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$596.80
|
| Rate for Payer: GEHA Medicare |
$775.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Humana ChoiceCare |
$853.25
|
| Rate for Payer: Humana Medicare Advantage |
$775.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,303.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$327.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$775.68
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,318.66
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$378.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$327.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$775.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,551.36
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$760.17
|
| Rate for Payer: United Healthcare Commercial |
$634.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$775.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$775.68
|
| Rate for Payer: Zelis Auto |
$298.40
|
| Rate for Payer: Zelis Medicare |
$659.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$930.82
|
| Rate for Payer: Zelis Worker's Compensation |
$353.39
|
|
|
suscep, aero+ faculta anaero REF008680
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2299212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$8.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$9.52
|
| Rate for Payer: Humana Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.65
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.71
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.30
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.65
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$7.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.38
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
suscep, aero+ faculta anaero REF008680
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2299212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
SUSPEND BOWEL W/PROSTHESIS
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
CPT 44700
|
| Hospital Charge Code |
6144700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$583.67 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$1,817.30
|
| Rate for Payer: First Health Commercial |
$1,924.20
|
| Rate for Payer: First Health Workers Compensation |
$825.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,924.20
|
| Rate for Payer: GEHA Commercial |
$1,496.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,924.20
|
| Rate for Payer: Multiplan All |
$1,945.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,496.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,924.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,031.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,603.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,988.34
|
| Rate for Payer: Zelis Auto |
$855.20
|
| Rate for Payer: Zelis Worker's Compensation |
$583.67
|
|
|
SUSPEND BOWEL W/PROSTHESIS
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
CPT 44700
|
| Hospital Charge Code |
6144700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$534.50 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$1,817.30
|
| Rate for Payer: First Health Commercial |
$1,924.20
|
| Rate for Payer: First Health Workers Compensation |
$825.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,924.20
|
| Rate for Payer: GEHA Commercial |
$1,710.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,924.20
|
| Rate for Payer: Humana ChoiceCare |
$555.88
|
| Rate for Payer: Multiplan All |
$1,945.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,282.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,496.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,924.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,031.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,603.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,881.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$534.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,988.34
|
| Rate for Payer: Zelis Auto |
$855.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,069.00
|
| Rate for Payer: Zelis Worker's Compensation |
$583.67
|
|
|
SUSPENSION OF TESTIS
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT 54620
|
| Hospital Charge Code |
6154620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.57 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$697.50
|
| Rate for Payer: First Health Workers Compensation |
$299.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$697.50
|
| Rate for Payer: GEHA Commercial |
$542.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$697.50
|
| Rate for Payer: Multiplan All |
$705.25
|
| Rate for Payer: OMNI Networks Commercial |
$542.50
|
| Rate for Payer: One Health Plan PPO/POS |
$697.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$736.25
|
| Rate for Payer: Three Rivers Provider Network All |
$581.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$720.75
|
| Rate for Payer: Zelis Auto |
$310.00
|
| Rate for Payer: Zelis Worker's Compensation |
$211.57
|
|
|
SUSPENSION OF TESTIS
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT 54620
|
| Hospital Charge Code |
6154620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.57 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$465.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$697.50
|
| Rate for Payer: First Health Workers Compensation |
$299.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$697.50
|
| Rate for Payer: GEHA Commercial |
$620.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$697.50
|
| 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 |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$705.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$542.50
|
| Rate for Payer: One Health Plan PPO/POS |
$697.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$736.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$581.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$720.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$310.00
|
| 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 |
$211.57
|
|
|
SUSPENSION OF TESTIS
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 54640
|
| Hospital Charge Code |
6154640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.63 |
| Max. Negotiated Rate |
$934.80 |
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$836.40
|
| Rate for Payer: First Health Commercial |
$885.60
|
| Rate for Payer: First Health Workers Compensation |
$379.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$885.60
|
| Rate for Payer: GEHA Commercial |
$688.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$885.60
|
| Rate for Payer: Multiplan All |
$895.44
|
| Rate for Payer: OMNI Networks Commercial |
$688.80
|
| Rate for Payer: One Health Plan PPO/POS |
$885.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$934.80
|
| Rate for Payer: Three Rivers Provider Network All |
$738.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$915.12
|
| Rate for Payer: Zelis Auto |
$393.60
|
| Rate for Payer: Zelis Worker's Compensation |
$268.63
|
|
|
SUSPENSION OF TESTIS
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 54640
|
| Hospital Charge Code |
6154640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.63 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$590.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$836.40
|
| Rate for Payer: First Health Commercial |
$885.60
|
| Rate for Payer: First Health Workers Compensation |
$379.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$885.60
|
| Rate for Payer: GEHA Commercial |
$787.20
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$885.60
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$895.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$688.80
|
| Rate for Payer: One Health Plan PPO/POS |
$885.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$934.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$738.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$915.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$393.60
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$268.63
|
|
|
SUSPENSION OF VAGINA
|
Facility
|
IP
|
$1,943.00
|
|
|
Service Code
|
CPT 57280
|
| Hospital Charge Code |
6157280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$530.44 |
| Max. Negotiated Rate |
$1,845.85 |
| Rate for Payer: Cash Price |
$1,165.80
|
| Rate for Payer: Cigna Commercial |
$1,651.55
|
| Rate for Payer: First Health Commercial |
$1,748.70
|
| Rate for Payer: First Health Workers Compensation |
$750.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,748.70
|
| Rate for Payer: GEHA Commercial |
$1,360.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,748.70
|
| Rate for Payer: Multiplan All |
$1,768.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,360.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,748.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,845.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,457.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,806.99
|
| Rate for Payer: Zelis Auto |
$777.20
|
| Rate for Payer: Zelis Worker's Compensation |
$530.44
|
|
|
SUSPENSION OF VAGINA
|
Facility
|
OP
|
$1,943.00
|
|
|
Service Code
|
CPT 57280
|
| Hospital Charge Code |
6157280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.75 |
| Max. Negotiated Rate |
$1,845.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,165.80
|
| Rate for Payer: Cash Price |
$1,165.80
|
| Rate for Payer: Cigna Commercial |
$1,651.55
|
| Rate for Payer: First Health Commercial |
$1,748.70
|
| Rate for Payer: First Health Workers Compensation |
$750.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,748.70
|
| Rate for Payer: GEHA Commercial |
$1,554.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,748.70
|
| Rate for Payer: Humana ChoiceCare |
$505.18
|
| Rate for Payer: Multiplan All |
$1,768.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,165.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,360.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,748.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,845.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,457.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,709.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$485.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,806.99
|
| Rate for Payer: Zelis Auto |
$777.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$971.50
|
| Rate for Payer: Zelis Worker's Compensation |
$530.44
|
|
|
SUTURE BILE DUCT INJURY
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT 47900
|
| Hospital Charge Code |
6147900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cigna Commercial |
$2,448.00
|
| Rate for Payer: First Health Commercial |
$2,592.00
|
| Rate for Payer: First Health Workers Compensation |
$1,111.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,592.00
|
| Rate for Payer: GEHA Commercial |
$2,304.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,592.00
|
| Rate for Payer: Humana ChoiceCare |
$748.80
|
| Rate for Payer: Multiplan All |
$2,620.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,728.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,016.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,592.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,736.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,160.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,534.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$720.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,678.40
|
| Rate for Payer: Zelis Auto |
$1,152.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,440.00
|
| Rate for Payer: Zelis Worker's Compensation |
$786.24
|
|
|
SUTURE BILE DUCT INJURY
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT 47900
|
| Hospital Charge Code |
6147900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$786.24 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cigna Commercial |
$2,448.00
|
| Rate for Payer: First Health Commercial |
$2,592.00
|
| Rate for Payer: First Health Workers Compensation |
$1,111.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,592.00
|
| Rate for Payer: GEHA Commercial |
$2,016.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,592.00
|
| Rate for Payer: Multiplan All |
$2,620.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,016.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,592.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,736.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,160.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,678.40
|
| Rate for Payer: Zelis Auto |
$1,152.00
|
| Rate for Payer: Zelis Worker's Compensation |
$786.24
|
|
|
SUTURE LARGE INTESTINE
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 44604
|
| Hospital Charge Code |
6144604
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$608.52 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: First Health Workers Compensation |
$860.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,560.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
| Rate for Payer: Zelis Worker's Compensation |
$608.52
|
|
