|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
1900025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
1900025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$448.74
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
7211765
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$122.51 |
| Max. Negotiated Rate |
$426.30 |
| Rate for Payer: Cash Price |
$269.24
|
| Rate for Payer: Cigna Commercial |
$381.43
|
| Rate for Payer: First Health Commercial |
$403.87
|
| Rate for Payer: First Health Workers Compensation |
$173.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$403.87
|
| Rate for Payer: GEHA Commercial |
$314.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$403.87
|
| Rate for Payer: Multiplan All |
$408.35
|
| Rate for Payer: OMNI Networks Commercial |
$314.12
|
| Rate for Payer: One Health Plan PPO/POS |
$403.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.30
|
| Rate for Payer: Three Rivers Provider Network All |
$336.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.33
|
| Rate for Payer: Zelis Auto |
$179.50
|
| Rate for Payer: Zelis Worker's Compensation |
$122.51
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
21600085
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$240.55
|
| Rate for Payer: First Health Commercial |
$254.70
|
| Rate for Payer: First Health Workers Compensation |
$109.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.70
|
| Rate for Payer: GEHA Commercial |
$226.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$257.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: One Health Plan PPO/POS |
$254.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$212.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$263.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$113.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$77.26
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
21600085
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$240.55
|
| Rate for Payer: First Health Commercial |
$254.70
|
| Rate for Payer: First Health Workers Compensation |
$109.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.70
|
| Rate for Payer: GEHA Commercial |
$198.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.70
|
| Rate for Payer: Multiplan All |
$257.53
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: One Health Plan PPO/POS |
$254.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.85
|
| Rate for Payer: Three Rivers Provider Network All |
$212.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$263.19
|
| Rate for Payer: Zelis Auto |
$113.20
|
| Rate for Payer: Zelis Worker's Compensation |
$77.26
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
20300025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cigna Commercial |
$424.15
|
| Rate for Payer: First Health Commercial |
$449.10
|
| Rate for Payer: First Health Workers Compensation |
$192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$449.10
|
| Rate for Payer: GEHA Commercial |
$349.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$449.10
|
| Rate for Payer: Multiplan All |
$454.09
|
| Rate for Payer: OMNI Networks Commercial |
$349.30
|
| Rate for Payer: One Health Plan PPO/POS |
$449.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$474.05
|
| Rate for Payer: Three Rivers Provider Network All |
$374.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$464.07
|
| Rate for Payer: Zelis Auto |
$199.60
|
| Rate for Payer: Zelis Worker's Compensation |
$136.23
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
6111765
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$240.55
|
| Rate for Payer: First Health Commercial |
$254.70
|
| Rate for Payer: First Health Workers Compensation |
$109.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.70
|
| Rate for Payer: GEHA Commercial |
$198.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.70
|
| Rate for Payer: Multiplan All |
$257.53
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: One Health Plan PPO/POS |
$254.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.85
|
| Rate for Payer: Three Rivers Provider Network All |
$212.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$263.19
|
| Rate for Payer: Zelis Auto |
$113.20
|
| Rate for Payer: Zelis Worker's Compensation |
$77.26
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
20300025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$299.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cigna Commercial |
$424.15
|
| Rate for Payer: First Health Commercial |
$449.10
|
| Rate for Payer: First Health Workers Compensation |
$192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$449.10
|
| Rate for Payer: GEHA Commercial |
$399.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$449.10
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$454.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$349.30
|
| Rate for Payer: One Health Plan PPO/POS |
$449.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$474.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$374.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$464.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$199.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$136.23
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$448.74
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
8511765
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$122.51 |
| Max. Negotiated Rate |
$426.30 |
| Rate for Payer: Cash Price |
$269.24
|
| Rate for Payer: Cigna Commercial |
$381.43
|
| Rate for Payer: First Health Commercial |
$403.87
|
| Rate for Payer: First Health Workers Compensation |
$173.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$403.87
|
| Rate for Payer: GEHA Commercial |
$314.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$403.87
|
| Rate for Payer: Multiplan All |
$408.35
|
| Rate for Payer: OMNI Networks Commercial |
$314.12
|
| Rate for Payer: One Health Plan PPO/POS |
$403.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.30
|
| Rate for Payer: Three Rivers Provider Network All |
$336.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.33
|
| Rate for Payer: Zelis Auto |
$179.50
|
| Rate for Payer: Zelis Worker's Compensation |
$122.51
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$448.74
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
8511765
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$269.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$269.24
|
| Rate for Payer: Cash Price |
$269.24
|
| Rate for Payer: Cigna Commercial |
$381.43
|
| Rate for Payer: First Health Commercial |
$403.87
|
| Rate for Payer: First Health Workers Compensation |
$173.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$403.87
|
| Rate for Payer: GEHA Commercial |
$358.99
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$403.87
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$408.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$314.12
|
| Rate for Payer: One Health Plan PPO/POS |
$403.87
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$336.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$179.50
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$122.51
|
|
|
WEDGE RESECT OF LUNG ADD-ON
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 32506
|
| Hospital Charge Code |
6132506
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$427.55
|
| Rate for Payer: First Health Commercial |
$452.70
|
| Rate for Payer: First Health Workers Compensation |
$194.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$452.70
|
| Rate for Payer: GEHA Commercial |
$352.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Worker's Compensation |
$137.32
|
|
|
WEDGE RESECT OF LUNG ADD-ON
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 32506
|
| Hospital Charge Code |
6132506
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.75 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$427.55
|
| Rate for Payer: First Health Commercial |
$452.70
|
| Rate for Payer: First Health Workers Compensation |
$194.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$452.70
|
| Rate for Payer: GEHA Commercial |
$402.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Humana ChoiceCare |
$130.78
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$301.80
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$442.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$251.50
|
| Rate for Payer: Zelis Worker's Compensation |
$137.32
|
|
|
WEIGHT LOSS ESTABLISHED PATIENT
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
21600011
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
WEIGHT LOSS ESTABLISHED PATIENT
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
25500011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
WEIGHT LOSS ESTABLISHED PATIENT
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
21600011
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
WEIGHT LOSS ESTABLISHED PATIENT
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
25500011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
WEIGHT LOSS ESTABLISHED PATIENT
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
21500011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
WEIGHT LOSS ESTABLISHED PATIENT
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
21500011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
WEIGHT LOSS NEW PATIENT
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
25500010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
WEIGHT LOSS NEW PATIENT
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
21600010
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
WEIGHT LOSS NEW PATIENT
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
21600010
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
WEIGHT LOSS NEW PATIENT
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
21500010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
WEIGHT LOSS NEW PATIENT
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
21500010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
WEIGHT LOSS NEW PATIENT
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
25500010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
WEIGHT,TRACTION,CAST IRON #2
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
90007177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
