|
BUTTON ENDO FIXATN 20MM
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
90008512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.00 |
| Max. Negotiated Rate |
$1,151.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cigna Commercial |
$1,030.20
|
| Rate for Payer: First Health Commercial |
$1,090.80
|
| Rate for Payer: First Health Workers Compensation |
$467.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,090.80
|
| Rate for Payer: GEHA Commercial |
$969.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,090.80
|
| Rate for Payer: Humana ChoiceCare |
$315.12
|
| Rate for Payer: Multiplan All |
$1,102.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$727.20
|
| Rate for Payer: OMNI Networks Commercial |
$848.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,090.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,151.40
|
| Rate for Payer: Three Rivers Provider Network All |
$909.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,066.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,127.16
|
| Rate for Payer: Zelis Auto |
$484.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$606.00
|
| Rate for Payer: Zelis Worker's Compensation |
$330.88
|
|
|
BUTTON TIGHTROPE ABS
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.60 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.20
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$577.15
|
| Rate for Payer: First Health Commercial |
$611.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$611.10
|
| Rate for Payer: GEHA Commercial |
$475.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$611.10
|
| Rate for Payer: Multiplan All |
$617.89
|
| Rate for Payer: OMNI Networks Commercial |
$475.30
|
| Rate for Payer: One Health Plan PPO/POS |
$611.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$645.05
|
| Rate for Payer: Three Rivers Provider Network All |
$509.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$631.47
|
| Rate for Payer: Zelis Auto |
$271.60
|
|
|
BUTTON TIGHTROPE ABS
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.75 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$407.40
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$577.15
|
| Rate for Payer: First Health Commercial |
$611.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$611.10
|
| Rate for Payer: GEHA Commercial |
$543.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$611.10
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Multiplan All |
$617.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$407.40
|
| Rate for Payer: OMNI Networks Commercial |
$475.30
|
| Rate for Payer: One Health Plan PPO/POS |
$611.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$645.05
|
| Rate for Payer: Three Rivers Provider Network All |
$509.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$597.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$631.47
|
| Rate for Payer: Zelis Auto |
$271.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$339.50
|
|
|
BUTTON TIGHTROPE ABS CONCAVE
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.50 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$737.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Humana ChoiceCare |
$239.72
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$553.20
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$811.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$230.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$461.00
|
|
|
BUTTON TIGHTROPE ABS CONCAVE
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.50 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$737.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Humana ChoiceCare |
$239.72
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$553.20
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$811.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$230.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$461.00
|
|
|
BUTTON TIGHTROPE ABS CONCAVE
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.80 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$737.60
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$645.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
|
|
BUTTON TIGHTROPE ABS CONCAVE
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.50 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$737.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Humana ChoiceCare |
$239.72
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$553.20
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$811.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$230.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$461.00
|
|
|
BUTTON TIGHTROPE ABS CONCAVE
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.80 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$737.60
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$645.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
|
|
BUTTON TIGHTROPE ABS CONCAVE
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.80 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$737.60
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$645.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
|
|
BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Facility
|
OP
|
$3,487.00
|
|
| Hospital Charge Code |
8149180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$871.75 |
| Max. Negotiated Rate |
$3,312.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,092.20
|
| Rate for Payer: Cash Price |
$2,092.20
|
| Rate for Payer: Cigna Commercial |
$2,963.95
|
| Rate for Payer: First Health Commercial |
$3,138.30
|
| Rate for Payer: First Health Workers Compensation |
$1,346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,138.30
|
| Rate for Payer: GEHA Commercial |
$2,789.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,138.30
|
| Rate for Payer: Humana ChoiceCare |
$906.62
|
| Rate for Payer: Multiplan All |
$3,173.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,092.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,440.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,138.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,312.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,615.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,068.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$871.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,242.91
|
| Rate for Payer: Zelis Auto |
$1,394.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,743.50
|
| Rate for Payer: Zelis Worker's Compensation |
$951.95
|
|
|
BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Facility
|
IP
|
$3,487.00
|
|
| Hospital Charge Code |
8149180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$951.95 |
| Max. Negotiated Rate |
$3,312.65 |
| Rate for Payer: Cash Price |
$2,092.20
|
| Rate for Payer: Cigna Commercial |
$2,963.95
|
| Rate for Payer: First Health Commercial |
$3,138.30
|
| Rate for Payer: First Health Workers Compensation |
$1,346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,138.30
|
| Rate for Payer: GEHA Commercial |
$2,440.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,138.30
|
| Rate for Payer: Multiplan All |
$3,173.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,440.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,138.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,312.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,615.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,242.91
|
| Rate for Payer: Zelis Auto |
$1,394.80
|
| Rate for Payer: Zelis Worker's Compensation |
$951.95
|
|
|
BX & ASP BONE MARROW
|
Facility
|
IP
|
$771.00
|
|
| Hospital Charge Code |
2401122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.48 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: First Health Workers Compensation |
$297.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$539.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Worker's Compensation |
$210.48
|
|
|
BX & ASP BONE MARROW
|
Facility
|
OP
|
$771.00
|
|
| Hospital Charge Code |
2401122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.75 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: First Health Workers Compensation |
$297.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$616.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Humana ChoiceCare |
$200.46
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$462.60
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$678.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$385.50
|
| Rate for Payer: Zelis Worker's Compensation |
$210.48
|
|
|
BX BACK/FLANK DEEP
|
Facility
|
OP
|
$3,526.00
|
|
| Hospital Charge Code |
2407243
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$881.50 |
| Max. Negotiated Rate |
$3,349.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,115.60
|
| Rate for Payer: Cash Price |
$2,115.60
|
| Rate for Payer: Cigna Commercial |
$2,997.10
|
| Rate for Payer: First Health Commercial |
$3,173.40
|
| Rate for Payer: First Health Workers Compensation |
$1,361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,173.40
|
| Rate for Payer: GEHA Commercial |
$2,820.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,173.40
|
| Rate for Payer: Humana ChoiceCare |
$916.76
|
| Rate for Payer: Multiplan All |
$3,208.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,115.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,468.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,173.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,349.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,644.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,102.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$881.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,279.18
|
| Rate for Payer: Zelis Auto |
$1,410.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,763.00
|
| Rate for Payer: Zelis Worker's Compensation |
$962.60
|
|
|
BX BACK/FLANK DEEP
|
Facility
|
IP
|
$3,526.00
|
|
| Hospital Charge Code |
2407243
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$962.60 |
| Max. Negotiated Rate |
$3,349.70 |
| Rate for Payer: Cash Price |
$2,115.60
|
| Rate for Payer: Cigna Commercial |
$2,997.10
|
| Rate for Payer: First Health Commercial |
$3,173.40
|
| Rate for Payer: First Health Workers Compensation |
$1,361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,173.40
|
| Rate for Payer: GEHA Commercial |
$2,468.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,173.40
|
| Rate for Payer: Multiplan All |
$3,208.66
|
| Rate for Payer: OMNI Networks Commercial |
$2,468.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,173.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,349.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,644.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,279.18
|
| Rate for Payer: Zelis Auto |
$1,410.40
|
| Rate for Payer: Zelis Worker's Compensation |
$962.60
|
|
|
BX BACK/FLANK SUPERF
|
Facility
|
OP
|
$1,945.00
|
|
| Hospital Charge Code |
2407242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.25 |
| Max. Negotiated Rate |
$1,847.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,167.00
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,653.25
|
| Rate for Payer: First Health Commercial |
$1,750.50
|
| Rate for Payer: First Health Workers Compensation |
$750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,750.50
|
| Rate for Payer: GEHA Commercial |
$1,556.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,750.50
|
| Rate for Payer: Humana ChoiceCare |
$505.70
|
| Rate for Payer: Multiplan All |
$1,769.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,167.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,361.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,750.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,847.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,458.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,711.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$486.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,808.85
|
| Rate for Payer: Zelis Auto |
$778.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$972.50
|
| Rate for Payer: Zelis Worker's Compensation |
$530.99
|
|
|
BX BACK/FLANK SUPERF
|
Facility
|
IP
|
$1,945.00
|
|
| Hospital Charge Code |
2407242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$530.99 |
| Max. Negotiated Rate |
$1,847.75 |
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,653.25
|
| Rate for Payer: First Health Commercial |
$1,750.50
|
| Rate for Payer: First Health Workers Compensation |
$750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,750.50
|
| Rate for Payer: GEHA Commercial |
$1,361.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,750.50
|
| Rate for Payer: Multiplan All |
$1,769.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,361.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,750.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,847.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,458.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,808.85
|
| Rate for Payer: Zelis Auto |
$778.00
|
| Rate for Payer: Zelis Worker's Compensation |
$530.99
|
|
|
BX BONE ILIUM, STERN
|
Facility
|
IP
|
$1,547.00
|
|
| Hospital Charge Code |
2410067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$422.33 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cigna Commercial |
$1,314.95
|
| Rate for Payer: First Health Commercial |
$1,392.30
|
| Rate for Payer: First Health Workers Compensation |
$597.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,392.30
|
| Rate for Payer: GEHA Commercial |
$1,082.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,392.30
|
| Rate for Payer: Multiplan All |
$1,407.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,392.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,469.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,438.71
|
| Rate for Payer: Zelis Auto |
$618.80
|
| Rate for Payer: Zelis Worker's Compensation |
$422.33
|
|
|
BX BONE ILIUM, STERN
|
Facility
|
OP
|
$1,547.00
|
|
| Hospital Charge Code |
2410067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.20
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cigna Commercial |
$1,314.95
|
| Rate for Payer: First Health Commercial |
$1,392.30
|
| Rate for Payer: First Health Workers Compensation |
$597.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,392.30
|
| Rate for Payer: GEHA Commercial |
$1,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,392.30
|
| Rate for Payer: Humana ChoiceCare |
$402.22
|
| Rate for Payer: Multiplan All |
$1,407.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$928.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,392.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,469.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,361.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$386.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,438.71
|
| Rate for Payer: Zelis Auto |
$618.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$773.50
|
| Rate for Payer: Zelis Worker's Compensation |
$422.33
|
|
|
BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
6119100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.33 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$85.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Worker's Compensation |
$60.33
|
|
|
BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
6119100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.33 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$85.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$60.33
|
|
|
BX BREAST W/DEV 1ST LESION MRI GUIDANCE
|
Facility
|
IP
|
$6,145.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
7719085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$5,837.75 |
| Rate for Payer: Cash Price |
$3,687.00
|
| Rate for Payer: Cigna Commercial |
$5,223.25
|
| Rate for Payer: First Health Commercial |
$5,530.50
|
| Rate for Payer: First Health Workers Compensation |
$2,372.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,530.50
|
| Rate for Payer: GEHA Commercial |
$4,301.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,530.50
|
| Rate for Payer: Multiplan All |
$5,591.95
|
| Rate for Payer: OMNI Networks Commercial |
$4,301.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,530.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,837.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,608.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,714.85
|
| Rate for Payer: Zelis Auto |
$2,458.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,677.59
|
|
|
BX BREAST W/DEV 1ST LESION MRI GUIDANCE
|
Facility
|
OP
|
$6,145.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
7719085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.82 |
| Max. Negotiated Rate |
$5,837.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,687.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$773.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,687.00
|
| Rate for Payer: Cash Price |
$3,687.00
|
| Rate for Payer: Cigna Commercial |
$5,223.25
|
| Rate for Payer: First Health Commercial |
$5,530.50
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,530.50
|
| Rate for Payer: GEHA Commercial |
$4,916.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,530.50
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$789.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$5,591.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,301.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,530.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$911.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$789.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,837.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$4,608.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,714.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,458.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
BX BREAST W/DEV 1ST LESION STEREOTACT GD
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
7719081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,544.91 |
| Max. Negotiated Rate |
$5,376.05 |
| Rate for Payer: Cash Price |
$3,395.40
|
| Rate for Payer: Cigna Commercial |
$4,810.15
|
| Rate for Payer: First Health Commercial |
$5,093.10
|
| Rate for Payer: First Health Workers Compensation |
$2,184.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,093.10
|
| Rate for Payer: GEHA Commercial |
$3,961.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,093.10
|
| Rate for Payer: Multiplan All |
$5,149.69
|
| Rate for Payer: OMNI Networks Commercial |
$3,961.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,093.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,376.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,244.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,262.87
|
| Rate for Payer: Zelis Auto |
$2,263.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,544.91
|
|
|
BX BREAST W/DEV 1ST LESION STEREOTACT GD
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
7719081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.82 |
| Max. Negotiated Rate |
$5,376.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,395.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$773.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,395.40
|
| Rate for Payer: Cash Price |
$3,395.40
|
| Rate for Payer: Cigna Commercial |
$4,810.15
|
| Rate for Payer: First Health Commercial |
$5,093.10
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,093.10
|
| Rate for Payer: GEHA Commercial |
$4,527.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,093.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$789.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$5,149.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,961.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,093.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$911.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$789.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,376.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$4,244.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,262.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,263.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
