|
BX BREAST W/DEV ADDL LESION MRI GUIDANCE
|
Facility
|
IP
|
$4,766.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
7719086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.12 |
| Max. Negotiated Rate |
$4,527.70 |
| Rate for Payer: Cash Price |
$2,859.60
|
| Rate for Payer: Cigna Commercial |
$4,051.10
|
| Rate for Payer: First Health Commercial |
$4,289.40
|
| Rate for Payer: First Health Workers Compensation |
$1,840.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,289.40
|
| Rate for Payer: GEHA Commercial |
$3,336.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,289.40
|
| Rate for Payer: Multiplan All |
$4,337.06
|
| Rate for Payer: OMNI Networks Commercial |
$3,336.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,289.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,527.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,574.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,432.38
|
| Rate for Payer: Zelis Auto |
$1,906.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,301.12
|
|
|
BX BREAST W/DEV ADDL LESION MRI GUIDANCE
|
Facility
|
OP
|
$4,766.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
7719086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,172.80 |
| Max. Negotiated Rate |
$4,527.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,859.60
|
| Rate for Payer: Cash Price |
$2,859.60
|
| Rate for Payer: Cash Price |
$2,859.60
|
| Rate for Payer: Cigna Commercial |
$4,051.10
|
| Rate for Payer: First Health Commercial |
$4,289.40
|
| Rate for Payer: First Health Workers Compensation |
$1,658.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,289.40
|
| Rate for Payer: GEHA Commercial |
$3,812.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,289.40
|
| Rate for Payer: Humana ChoiceCare |
$1,239.16
|
| Rate for Payer: Multiplan All |
$4,337.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,859.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,336.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,289.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,527.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,574.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,194.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,191.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,432.38
|
| Rate for Payer: Zelis Auto |
$1,906.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,383.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,172.80
|
|
|
BX BREAST W/DEV ADDL LESION STEREOTAC GD
|
Facility
|
IP
|
$4,038.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
7719082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,102.37 |
| Max. Negotiated Rate |
$3,836.10 |
| Rate for Payer: Cash Price |
$2,422.80
|
| Rate for Payer: Cigna Commercial |
$3,432.30
|
| Rate for Payer: First Health Commercial |
$3,634.20
|
| Rate for Payer: First Health Workers Compensation |
$1,559.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,634.20
|
| Rate for Payer: GEHA Commercial |
$2,826.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,634.20
|
| Rate for Payer: Multiplan All |
$3,674.58
|
| Rate for Payer: OMNI Networks Commercial |
$2,826.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,634.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,836.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,028.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,755.34
|
| Rate for Payer: Zelis Auto |
$1,615.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,102.37
|
|
|
BX BREAST W/DEV ADDL LESION STEREOTAC GD
|
Facility
|
OP
|
$4,038.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
7719082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.29 |
| Max. Negotiated Rate |
$3,836.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,422.80
|
| Rate for Payer: Cash Price |
$2,422.80
|
| Rate for Payer: Cash Price |
$2,422.80
|
| Rate for Payer: Cigna Commercial |
$3,432.30
|
| Rate for Payer: First Health Commercial |
$3,634.20
|
| Rate for Payer: First Health Workers Compensation |
$1,086.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,634.20
|
| Rate for Payer: GEHA Commercial |
$3,230.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,634.20
|
| Rate for Payer: Humana ChoiceCare |
$1,049.88
|
| Rate for Payer: Multiplan All |
$3,674.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,422.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,826.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,634.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,836.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,028.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,553.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,009.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,755.34
|
| Rate for Payer: Zelis Auto |
$1,615.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,019.00
|
| Rate for Payer: Zelis Worker's Compensation |
$768.29
|
|
|
BX BREAST W/US GUID
|
Facility
|
IP
|
$1,878.00
|
|
| Hospital Charge Code |
2406517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$512.69 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: First Health Workers Compensation |
$725.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,314.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Worker's Compensation |
$512.69
|
|
|
BX BREAST W/US GUID
|
Facility
|
OP
|
$1,878.00
|
|
| Hospital Charge Code |
2406517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$469.50 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: First Health Workers Compensation |
$725.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,502.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Humana ChoiceCare |
$488.28
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,126.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,652.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$939.00
|
| Rate for Payer: Zelis Worker's Compensation |
$512.69
|
|
|
BX/EXC IDRL SPINE LESN LMBR
|
Facility
|
IP
|
$4,208.00
|
|
|
Service Code
|
CPT 63282
|
| Hospital Charge Code |
6163282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,148.78 |
| Max. Negotiated Rate |
$3,997.60 |
| Rate for Payer: Cash Price |
$2,524.80
|
| Rate for Payer: Cigna Commercial |
$3,576.80
|
| Rate for Payer: First Health Commercial |
$3,787.20
|
| Rate for Payer: First Health Workers Compensation |
$1,624.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,787.20
|
| Rate for Payer: GEHA Commercial |
$2,945.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,787.20
|
| Rate for Payer: Multiplan All |
$3,829.28
|
| Rate for Payer: OMNI Networks Commercial |
$2,945.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,787.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,997.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,913.44
|
| Rate for Payer: Zelis Auto |
$1,683.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,148.78
|
|
|
BX/EXC IDRL SPINE LESN LMBR
|
Facility
|
OP
|
$4,208.00
|
|
|
Service Code
|
CPT 63282
|
| Hospital Charge Code |
6163282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,052.00 |
| Max. Negotiated Rate |
$3,997.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,524.80
|
| Rate for Payer: Cash Price |
$2,524.80
|
| Rate for Payer: Cigna Commercial |
$3,576.80
|
| Rate for Payer: First Health Commercial |
$3,787.20
|
| Rate for Payer: First Health Workers Compensation |
$1,624.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,787.20
|
| Rate for Payer: GEHA Commercial |
$3,366.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,787.20
|
| Rate for Payer: Humana ChoiceCare |
$1,094.08
|
| Rate for Payer: Multiplan All |
$3,829.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,524.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,945.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,787.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,997.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,156.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,703.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,052.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,913.44
|
| Rate for Payer: Zelis Auto |
$1,683.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,148.78
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
8300049
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$261.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Worker's Compensation |
$102.10
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
20300069
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$790.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$790.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$625.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$299.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| 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 |
$638.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$737.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$638.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$638.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$149.60
|
| 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 |
$102.10
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
20300069
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$261.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Worker's Compensation |
$102.10
|
|
|
BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
8300049
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$790.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$790.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$625.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$299.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| 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 |
$638.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$737.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$638.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$638.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$149.60
|
| 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 |
$102.10
|
|
|
BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
20300068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$7,272.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,488.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,488.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,971.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$825.60
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,011.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,322.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,011.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,011.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$281.74
|
|
|
BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
6138500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
6138500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$7,272.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,488.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,488.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,971.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$646.40
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,011.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,322.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,011.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,011.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
20300068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Worker's Compensation |
$281.74
|
|
|
BX/EXC LYMPH NODES N
|
Facility
|
OP
|
$1,959.00
|
|
| Hospital Charge Code |
2407240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$489.75 |
| Max. Negotiated Rate |
$1,861.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$1,665.15
|
| Rate for Payer: First Health Commercial |
$1,763.10
|
| Rate for Payer: First Health Workers Compensation |
$756.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,763.10
|
| Rate for Payer: GEHA Commercial |
$1,567.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,763.10
|
| Rate for Payer: Humana ChoiceCare |
$509.34
|
| Rate for Payer: Multiplan All |
$1,782.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,175.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,371.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,763.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,861.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,469.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,723.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$489.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,821.87
|
| Rate for Payer: Zelis Auto |
$783.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$979.50
|
| Rate for Payer: Zelis Worker's Compensation |
$534.81
|
|
|
BX/EXC LYMPH NODES N
|
Facility
|
IP
|
$1,959.00
|
|
| Hospital Charge Code |
2407240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$534.81 |
| Max. Negotiated Rate |
$1,861.05 |
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$1,665.15
|
| Rate for Payer: First Health Commercial |
$1,763.10
|
| Rate for Payer: First Health Workers Compensation |
$756.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,763.10
|
| Rate for Payer: GEHA Commercial |
$1,371.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,763.10
|
| Rate for Payer: Multiplan All |
$1,782.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,371.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,763.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,861.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,469.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,821.87
|
| Rate for Payer: Zelis Auto |
$783.60
|
| Rate for Payer: Zelis Worker's Compensation |
$534.81
|
|
|
BX/EXC XDRL SPINE LESN SCRL
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
CPT 63278
|
| Hospital Charge Code |
6163278
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$935.57 |
| Max. Negotiated Rate |
$3,255.65 |
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cigna Commercial |
$2,912.95
|
| Rate for Payer: First Health Commercial |
$3,084.30
|
| Rate for Payer: First Health Workers Compensation |
$1,323.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,084.30
|
| Rate for Payer: GEHA Commercial |
$2,398.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,084.30
|
| Rate for Payer: Multiplan All |
$3,118.57
|
| Rate for Payer: OMNI Networks Commercial |
$2,398.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,084.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,255.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,570.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,187.11
|
| Rate for Payer: Zelis Auto |
$1,370.80
|
| Rate for Payer: Zelis Worker's Compensation |
$935.57
|
|
|
BX/EXC XDRL SPINE LESN SCRL
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
CPT 63278
|
| Hospital Charge Code |
6163278
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$856.75 |
| Max. Negotiated Rate |
$3,255.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,056.20
|
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cigna Commercial |
$2,912.95
|
| Rate for Payer: First Health Commercial |
$3,084.30
|
| Rate for Payer: First Health Workers Compensation |
$1,323.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,084.30
|
| Rate for Payer: GEHA Commercial |
$2,741.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,084.30
|
| Rate for Payer: Humana ChoiceCare |
$891.02
|
| Rate for Payer: Multiplan All |
$3,118.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,056.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,398.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,084.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,255.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,570.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,015.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$856.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,187.11
|
| Rate for Payer: Zelis Auto |
$1,370.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,713.50
|
| Rate for Payer: Zelis Worker's Compensation |
$935.57
|
|
|
BX LIVER
|
Facility
|
OP
|
$1,547.00
|
|
| Hospital Charge Code |
2407227
|
|
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 LIVER
|
Facility
|
IP
|
$1,547.00
|
|
| Hospital Charge Code |
2407227
|
|
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 SOFT TIS SHLDR DE
|
Facility
|
IP
|
$3,254.00
|
|
| Hospital Charge Code |
2410070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$888.34 |
| Max. Negotiated Rate |
$3,091.30 |
| Rate for Payer: Cash Price |
$1,952.40
|
| Rate for Payer: Cigna Commercial |
$2,765.90
|
| Rate for Payer: First Health Commercial |
$2,928.60
|
| Rate for Payer: First Health Workers Compensation |
$1,256.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,928.60
|
| Rate for Payer: GEHA Commercial |
$2,277.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,928.60
|
| Rate for Payer: Multiplan All |
$2,961.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,277.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,928.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,091.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,440.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,026.22
|
| Rate for Payer: Zelis Auto |
$1,301.60
|
| Rate for Payer: Zelis Worker's Compensation |
$888.34
|
|
|
BX SOFT TIS SHLDR DE
|
Facility
|
OP
|
$3,254.00
|
|
| Hospital Charge Code |
2410070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$813.50 |
| Max. Negotiated Rate |
$3,091.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,952.40
|
| Rate for Payer: Cash Price |
$1,952.40
|
| Rate for Payer: Cigna Commercial |
$2,765.90
|
| Rate for Payer: First Health Commercial |
$2,928.60
|
| Rate for Payer: First Health Workers Compensation |
$1,256.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,928.60
|
| Rate for Payer: GEHA Commercial |
$2,603.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,928.60
|
| Rate for Payer: Humana ChoiceCare |
$846.04
|
| Rate for Payer: Multiplan All |
$2,961.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,952.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,277.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,928.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,091.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,440.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,863.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$813.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,026.22
|
| Rate for Payer: Zelis Auto |
$1,301.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,627.00
|
| Rate for Payer: Zelis Worker's Compensation |
$888.34
|
|
|
BX SOFT TIS SHLDR SU
|
Facility
|
IP
|
$1,395.00
|
|
| Hospital Charge Code |
2410069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$380.83 |
| Max. Negotiated Rate |
$1,325.25 |
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$1,185.75
|
| Rate for Payer: First Health Commercial |
$1,255.50
|
| Rate for Payer: First Health Workers Compensation |
$538.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,255.50
|
| Rate for Payer: GEHA Commercial |
$976.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,255.50
|
| Rate for Payer: Multiplan All |
$1,269.45
|
| Rate for Payer: OMNI Networks Commercial |
$976.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,255.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,325.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,046.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,297.35
|
| Rate for Payer: Zelis Auto |
$558.00
|
| Rate for Payer: Zelis Worker's Compensation |
$380.83
|
|
