|
TRANSAB ESOPH HIAT HERN RPR
|
Facility
|
OP
|
$2,451.00
|
|
|
Service Code
|
CPT 43332
|
| Hospital Charge Code |
6143332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$612.75 |
| Max. Negotiated Rate |
$2,328.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,470.60
|
| Rate for Payer: Cash Price |
$1,470.60
|
| Rate for Payer: Cigna Commercial |
$2,083.35
|
| Rate for Payer: First Health Commercial |
$2,205.90
|
| Rate for Payer: First Health Workers Compensation |
$946.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,205.90
|
| Rate for Payer: GEHA Commercial |
$1,960.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,205.90
|
| Rate for Payer: Humana ChoiceCare |
$637.26
|
| Rate for Payer: Multiplan All |
$2,230.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,470.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,715.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,205.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,328.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,838.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,156.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$612.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,279.43
|
| Rate for Payer: Zelis Auto |
$980.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,225.50
|
| Rate for Payer: Zelis Worker's Compensation |
$669.12
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT 43333
|
| Hospital Charge Code |
6143333
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$667.75 |
| Max. Negotiated Rate |
$2,537.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,602.60
|
| Rate for Payer: Cash Price |
$1,602.60
|
| Rate for Payer: Cigna Commercial |
$2,270.35
|
| Rate for Payer: First Health Commercial |
$2,403.90
|
| Rate for Payer: First Health Workers Compensation |
$1,031.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,403.90
|
| Rate for Payer: GEHA Commercial |
$2,136.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,403.90
|
| Rate for Payer: Humana ChoiceCare |
$694.46
|
| Rate for Payer: Multiplan All |
$2,430.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,602.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,869.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,403.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,537.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,003.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,350.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$667.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,484.03
|
| Rate for Payer: Zelis Auto |
$1,068.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,335.50
|
| Rate for Payer: Zelis Worker's Compensation |
$729.18
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Facility
|
IP
|
$2,451.00
|
|
|
Service Code
|
CPT 43332
|
| Hospital Charge Code |
6143332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$669.12 |
| Max. Negotiated Rate |
$2,328.45 |
| Rate for Payer: Cash Price |
$1,470.60
|
| Rate for Payer: Cigna Commercial |
$2,083.35
|
| Rate for Payer: First Health Commercial |
$2,205.90
|
| Rate for Payer: First Health Workers Compensation |
$946.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,205.90
|
| Rate for Payer: GEHA Commercial |
$1,715.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,205.90
|
| Rate for Payer: Multiplan All |
$2,230.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,715.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,205.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,328.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,838.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,279.43
|
| Rate for Payer: Zelis Auto |
$980.40
|
| Rate for Payer: Zelis Worker's Compensation |
$669.12
|
|
|
TRANS CARE MGT HIGH MDM F2F 7 CAL DAY DC
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
21600107
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: First Health Workers Compensation |
$264.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$111.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$187.00
|
|
|
TRANS CARE MGT HIGH MDM F2F 7 CAL DAY DC
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
21600107
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: First Health Workers Compensation |
$264.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Worker's Compensation |
$187.00
|
|
|
TRANS CARE MGT HIGH MDM F2F 7 CAL DAY DC
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9199496
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: First Health Workers Compensation |
$264.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$111.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$187.00
|
|
|
TRANS CARE MGT HIGH MDM F2F 7 CAL DAY DC
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9199496
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: First Health Workers Compensation |
$264.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Worker's Compensation |
$187.00
|
|
|
TRANS CRE MGT MOD MDM F2F 14 CAL DAY DC
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9199495
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$104.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$104.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$82.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: First Health Workers Compensation |
$188.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$84.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$97.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$84.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$132.95
|
|
|
TRANS CRE MGT MOD MDM F2F 14 CAL DAY DC
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9199495
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: First Health Workers Compensation |
$188.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Worker's Compensation |
$132.95
|
|
|
TRANS CRE MGT MOD MDM F2F 14 CAL DAY DC
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
21600108
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$104.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$104.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$82.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: First Health Workers Compensation |
$188.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$84.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$97.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$84.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$132.95
|
|
|
TRANS CRE MGT MOD MDM F2F 14 CAL DAY DC
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
21600108
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: First Health Workers Compensation |
$188.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Worker's Compensation |
$132.95
|
|
|
TRANSECT ARTERY SINUS
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 61611
|
| Hospital Charge Code |
6161611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$813.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Humana ChoiceCare |
$264.42
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$610.20
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$966.15
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$894.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$254.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$945.81
|
| Rate for Payer: Zelis Auto |
$406.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$508.50
|
| Rate for Payer: Zelis Worker's Compensation |
$277.64
|
|
|
TRANSECT ARTERY SINUS
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 61611
|
| Hospital Charge Code |
6161611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$711.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$966.15
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$945.81
|
| Rate for Payer: Zelis Auto |
$406.80
|
| Rate for Payer: Zelis Worker's Compensation |
$277.64
|
|
|
TRANSFER OF ABDOMINAL MUSCLE
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 27100
|
| Hospital Charge Code |
6127100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$457.55 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cigna Commercial |
$1,424.60
|
| Rate for Payer: First Health Commercial |
$1,508.40
|
| Rate for Payer: First Health Workers Compensation |
$647.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,508.40
|
| Rate for Payer: GEHA Commercial |
$1,173.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,508.40
|
| Rate for Payer: Multiplan All |
$1,525.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,173.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,508.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,592.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,257.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,558.68
|
| Rate for Payer: Zelis Auto |
$670.40
|
| Rate for Payer: Zelis Worker's Compensation |
$457.55
|
|
|
TRANSFER OF ABDOMINAL MUSCLE
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 27100
|
| Hospital Charge Code |
6127100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$457.55 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,005.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cigna Commercial |
$1,424.60
|
| Rate for Payer: First Health Commercial |
$1,508.40
|
| Rate for Payer: First Health Workers Compensation |
$647.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,508.40
|
| Rate for Payer: GEHA Commercial |
$1,340.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,508.40
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,525.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,173.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,508.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,592.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,257.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,558.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$670.40
|
| 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 |
$457.55
|
|
|
TRANSFER OF ILIOPSOAS MUSCLE
|
Facility
|
IP
|
$1,989.00
|
|
|
Service Code
|
CPT 27110
|
| Hospital Charge Code |
6127110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$1,889.55 |
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$1,690.65
|
| Rate for Payer: First Health Commercial |
$1,790.10
|
| Rate for Payer: First Health Workers Compensation |
$767.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.10
|
| Rate for Payer: GEHA Commercial |
$1,392.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.10
|
| Rate for Payer: Multiplan All |
$1,809.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,889.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,849.77
|
| Rate for Payer: Zelis Auto |
$795.60
|
| Rate for Payer: Zelis Worker's Compensation |
$543.00
|
|
|
TRANSFER OF ILIOPSOAS MUSCLE
|
Facility
|
OP
|
$1,849.00
|
|
|
Service Code
|
CPT 27111
|
| Hospital Charge Code |
6127111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$504.78 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,109.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cigna Commercial |
$1,571.65
|
| Rate for Payer: First Health Commercial |
$1,664.10
|
| Rate for Payer: First Health Workers Compensation |
$713.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,664.10
|
| Rate for Payer: GEHA Commercial |
$1,479.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,664.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,682.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,294.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,664.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,756.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,719.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$739.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$504.78
|
|
|
TRANSFER OF ILIOPSOAS MUSCLE
|
Facility
|
IP
|
$1,849.00
|
|
|
Service Code
|
CPT 27111
|
| Hospital Charge Code |
6127111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$504.78 |
| Max. Negotiated Rate |
$1,756.55 |
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cigna Commercial |
$1,571.65
|
| Rate for Payer: First Health Commercial |
$1,664.10
|
| Rate for Payer: First Health Workers Compensation |
$713.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,664.10
|
| Rate for Payer: GEHA Commercial |
$1,294.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,664.10
|
| Rate for Payer: Multiplan All |
$1,682.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,294.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,664.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,756.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,719.57
|
| Rate for Payer: Zelis Auto |
$739.60
|
| Rate for Payer: Zelis Worker's Compensation |
$504.78
|
|
|
TRANSFER OF ILIOPSOAS MUSCLE
|
Facility
|
OP
|
$1,989.00
|
|
|
Service Code
|
CPT 27110
|
| Hospital Charge Code |
6127110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,193.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$1,690.65
|
| Rate for Payer: First Health Commercial |
$1,790.10
|
| Rate for Payer: First Health Workers Compensation |
$767.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.10
|
| Rate for Payer: GEHA Commercial |
$1,591.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.10
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,809.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,889.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,849.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$795.60
|
| 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 |
$543.00
|
|
|
TRANSFER OF SPINAL MUSCLE
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
CPT 27105
|
| Hospital Charge Code |
6127105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.94 |
| Max. Negotiated Rate |
$1,691.00 |
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,513.00
|
| Rate for Payer: First Health Commercial |
$1,602.00
|
| Rate for Payer: First Health Workers Compensation |
$687.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,602.00
|
| Rate for Payer: GEHA Commercial |
$1,246.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,602.00
|
| Rate for Payer: Multiplan All |
$1,619.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,246.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,602.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,691.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,335.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,655.40
|
| Rate for Payer: Zelis Auto |
$712.00
|
| Rate for Payer: Zelis Worker's Compensation |
$485.94
|
|
|
TRANSFER OF SPINAL MUSCLE
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
CPT 27105
|
| Hospital Charge Code |
6127105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.94 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,068.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,513.00
|
| Rate for Payer: First Health Commercial |
$1,602.00
|
| Rate for Payer: First Health Workers Compensation |
$687.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,602.00
|
| Rate for Payer: GEHA Commercial |
$1,424.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,602.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,619.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,246.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,602.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,691.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,335.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,655.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$712.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$485.94
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,730.88 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
transferrin REF 004937
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
2232302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$19.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$105.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.84
|
|
|
transferrin REF 004937
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
2232302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$19.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$12.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$14.04
|
| Rate for Payer: Humana Medicare Advantage |
$12.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.76
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.69
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.52
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.50
|
| Rate for Payer: United Healthcare Commercial |
$127.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.76
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$10.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.31
|
| Rate for Payer: Zelis Worker's Compensation |
$13.84
|
|
|
TRANSFERRIN (Vitros)
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
2232212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$19.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$12.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$14.04
|
| Rate for Payer: Humana Medicare Advantage |
$12.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.76
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.69
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.52
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.50
|
| Rate for Payer: United Healthcare Commercial |
$127.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.76
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$10.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.31
|
| Rate for Payer: Zelis Worker's Compensation |
$13.84
|
|
