|
DECOMPRESSIVE CRANIOTOMY
|
Facility
|
OP
|
$5,121.00
|
|
|
Service Code
|
CPT 61322
|
| Hospital Charge Code |
6161322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,280.25 |
| Max. Negotiated Rate |
$4,864.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,072.60
|
| Rate for Payer: Cash Price |
$3,072.60
|
| Rate for Payer: Cigna Commercial |
$4,352.85
|
| Rate for Payer: First Health Commercial |
$4,608.90
|
| Rate for Payer: First Health Workers Compensation |
$1,977.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,608.90
|
| Rate for Payer: GEHA Commercial |
$4,096.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,608.90
|
| Rate for Payer: Humana ChoiceCare |
$1,331.46
|
| Rate for Payer: Multiplan All |
$4,660.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,072.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,584.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,608.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,864.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,840.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,506.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,280.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,762.53
|
| Rate for Payer: Zelis Auto |
$2,048.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,560.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,398.03
|
|
|
DECOMPRESS SMALL BOWEL
|
Facility
|
IP
|
$2,049.00
|
|
|
Service Code
|
CPT 44021
|
| Hospital Charge Code |
6144021
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$559.38 |
| Max. Negotiated Rate |
$1,946.55 |
| Rate for Payer: Cash Price |
$1,229.40
|
| Rate for Payer: Cigna Commercial |
$1,741.65
|
| Rate for Payer: First Health Commercial |
$1,844.10
|
| Rate for Payer: First Health Workers Compensation |
$791.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,844.10
|
| Rate for Payer: GEHA Commercial |
$1,434.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,844.10
|
| Rate for Payer: Multiplan All |
$1,864.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,434.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,844.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,946.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,536.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,905.57
|
| Rate for Payer: Zelis Auto |
$819.60
|
| Rate for Payer: Zelis Worker's Compensation |
$559.38
|
|
|
DECOMPRESS SMALL BOWEL
|
Facility
|
OP
|
$2,049.00
|
|
|
Service Code
|
CPT 44021
|
| Hospital Charge Code |
6144021
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.25 |
| Max. Negotiated Rate |
$1,946.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,229.40
|
| Rate for Payer: Cash Price |
$1,229.40
|
| Rate for Payer: Cigna Commercial |
$1,741.65
|
| Rate for Payer: First Health Commercial |
$1,844.10
|
| Rate for Payer: First Health Workers Compensation |
$791.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,844.10
|
| Rate for Payer: GEHA Commercial |
$1,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,844.10
|
| Rate for Payer: Humana ChoiceCare |
$532.74
|
| Rate for Payer: Multiplan All |
$1,864.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,229.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,434.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,844.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,946.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,536.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,803.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$512.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,905.57
|
| Rate for Payer: Zelis Auto |
$819.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,024.50
|
| Rate for Payer: Zelis Worker's Compensation |
$559.38
|
|
|
DEEP MUSCLE BIOPSY
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
6120205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$343.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| Rate for Payer: Multiplan All |
$445.90
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$465.50
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$455.70
|
| Rate for Payer: Zelis Auto |
$196.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.77
|
|
|
DEEP MUSCLE BIOPSY
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
6120205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$392.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$445.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$465.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$455.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$196.00
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$133.77
|
|
|
DELAY FLAP ARMS/LEGS
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 15610
|
| Hospital Charge Code |
6115610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: First Health Workers Compensation |
$233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$484.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$165.16
|
|
|
DELAY FLAP ARMS/LEGS
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 15610
|
| Hospital Charge Code |
6115610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: First Health Workers Compensation |
$233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Worker's Compensation |
$165.16
|
|
|
DELAY FLAP EYE/NOS/EAR/LIP
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
6115630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$700.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
DELAY FLAP EYE/NOS/EAR/LIP
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
6115630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$612.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
DELAY FLAP F/C/C/N/AX/G/H/F
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 15620
|
| Hospital Charge Code |
6115620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.41 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$698.70
|
| Rate for Payer: First Health Commercial |
$739.80
|
| Rate for Payer: First Health Workers Compensation |
$317.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$739.80
|
| Rate for Payer: GEHA Commercial |
$575.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$739.80
|
| Rate for Payer: Multiplan All |
$748.02
|
| Rate for Payer: OMNI Networks Commercial |
$575.40
|
| Rate for Payer: One Health Plan PPO/POS |
$739.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$780.90
|
| Rate for Payer: Three Rivers Provider Network All |
$616.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$764.46
|
| Rate for Payer: Zelis Auto |
$328.80
|
| Rate for Payer: Zelis Worker's Compensation |
$224.41
|
|
|
DELAY FLAP F/C/C/N/AX/G/H/F
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 15620
|
| Hospital Charge Code |
6115620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.41 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$698.70
|
| Rate for Payer: First Health Commercial |
$739.80
|
| Rate for Payer: First Health Workers Compensation |
$317.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$739.80
|
| Rate for Payer: GEHA Commercial |
$657.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$739.80
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$748.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$575.40
|
| Rate for Payer: One Health Plan PPO/POS |
$739.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$780.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$616.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$764.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$328.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$224.41
|
|
|
DELAY FLAP TRUNK
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 15600
|
| Hospital Charge Code |
6115600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.14 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: First Health Workers Compensation |
$199.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$413.60
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$141.14
|
|
|
DELAY FLAP TRUNK
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 15600
|
| Hospital Charge Code |
6115600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.14 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: First Health Workers Compensation |
$199.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$361.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Worker's Compensation |
$141.14
|
|
|
DELIVERY OF PLACENTA ONLY
|
Facility
|
OP
|
$5,960.00
|
|
| Hospital Charge Code |
8159414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,490.00 |
| Max. Negotiated Rate |
$5,662.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,576.00
|
| Rate for Payer: Cash Price |
$3,576.00
|
| Rate for Payer: Cigna Commercial |
$5,066.00
|
| Rate for Payer: First Health Commercial |
$5,364.00
|
| Rate for Payer: First Health Workers Compensation |
$2,301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,364.00
|
| Rate for Payer: GEHA Commercial |
$4,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,364.00
|
| Rate for Payer: Humana ChoiceCare |
$1,549.60
|
| Rate for Payer: Multiplan All |
$5,423.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,576.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,172.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,364.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,662.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,470.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,244.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,490.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,542.80
|
| Rate for Payer: Zelis Auto |
$2,384.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,980.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,627.08
|
|
|
DELIVERY OF PLACENTA ONLY
|
Facility
|
IP
|
$5,960.00
|
|
| Hospital Charge Code |
8159414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,627.08 |
| Max. Negotiated Rate |
$5,662.00 |
| Rate for Payer: Cash Price |
$3,576.00
|
| Rate for Payer: Cigna Commercial |
$5,066.00
|
| Rate for Payer: First Health Commercial |
$5,364.00
|
| Rate for Payer: First Health Workers Compensation |
$2,301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,364.00
|
| Rate for Payer: GEHA Commercial |
$4,172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,364.00
|
| Rate for Payer: Multiplan All |
$5,423.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,172.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,364.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,662.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,470.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,542.80
|
| Rate for Payer: Zelis Auto |
$2,384.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,627.08
|
|
|
DELTA CER HEAD 12/14/28MM +8.5
|
Facility
|
OP
|
$5,750.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7005219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,437.50 |
| Max. Negotiated Rate |
$5,462.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,450.00
|
| Rate for Payer: Cash Price |
$3,450.00
|
| Rate for Payer: Cash Price |
$3,450.00
|
| Rate for Payer: Cigna Commercial |
$4,887.50
|
| Rate for Payer: First Health Commercial |
$5,175.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,175.00
|
| Rate for Payer: GEHA Commercial |
$4,600.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,175.00
|
| Rate for Payer: Humana ChoiceCare |
$1,495.00
|
| Rate for Payer: Multiplan All |
$5,232.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,450.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,025.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,175.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,462.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,312.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,060.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,437.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,347.50
|
| Rate for Payer: Zelis Auto |
$2,300.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,875.00
|
|
|
DELTA CER HEAD 12/14/28MM +8.5
|
Facility
|
IP
|
$5,750.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7005219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.00 |
| Max. Negotiated Rate |
$5,462.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,600.00
|
| Rate for Payer: Cash Price |
$3,450.00
|
| Rate for Payer: Cash Price |
$3,450.00
|
| Rate for Payer: Cigna Commercial |
$4,887.50
|
| Rate for Payer: First Health Commercial |
$5,175.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,175.00
|
| Rate for Payer: GEHA Commercial |
$4,025.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,175.00
|
| Rate for Payer: Multiplan All |
$5,232.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,025.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,175.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,462.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,312.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,347.50
|
| Rate for Payer: Zelis Auto |
$2,300.00
|
|
|
DEMECLOCYCLINE HCL 150 MG TAB
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 42806014301
|
| Hospital Charge Code |
3302936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$22.10
|
| Rate for Payer: First Health Commercial |
$23.40
|
| Rate for Payer: First Health Workers Compensation |
$10.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23.40
|
| Rate for Payer: GEHA Commercial |
$20.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23.40
|
| Rate for Payer: Humana ChoiceCare |
$6.76
|
| Rate for Payer: Multiplan All |
$23.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.60
|
| Rate for Payer: OMNI Networks Commercial |
$18.20
|
| Rate for Payer: One Health Plan PPO/POS |
$23.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$24.70
|
| Rate for Payer: Three Rivers Provider Network All |
$19.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24.18
|
| Rate for Payer: Zelis Auto |
$10.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.10
|
|
|
DEMECLOCYCLINE HCL 150 MG TAB
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 42806014301
|
| Hospital Charge Code |
3302936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$22.10
|
| Rate for Payer: First Health Commercial |
$23.40
|
| Rate for Payer: First Health Workers Compensation |
$10.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23.40
|
| Rate for Payer: GEHA Commercial |
$18.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23.40
|
| Rate for Payer: Multiplan All |
$23.66
|
| Rate for Payer: OMNI Networks Commercial |
$18.20
|
| Rate for Payer: One Health Plan PPO/POS |
$23.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$24.70
|
| Rate for Payer: Three Rivers Provider Network All |
$19.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24.18
|
| Rate for Payer: Zelis Auto |
$10.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.10
|
|
|
DENERVATION OF HIP JOINT
|
Facility
|
IP
|
$2,368.00
|
|
|
Service Code
|
CPT 27035
|
| Hospital Charge Code |
6127035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$646.46 |
| Max. Negotiated Rate |
$2,249.60 |
| Rate for Payer: Cash Price |
$1,420.80
|
| Rate for Payer: Cigna Commercial |
$2,012.80
|
| Rate for Payer: First Health Commercial |
$2,131.20
|
| Rate for Payer: First Health Workers Compensation |
$914.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,131.20
|
| Rate for Payer: GEHA Commercial |
$1,657.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,131.20
|
| Rate for Payer: Multiplan All |
$2,154.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,657.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,131.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,249.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,202.24
|
| Rate for Payer: Zelis Auto |
$947.20
|
| Rate for Payer: Zelis Worker's Compensation |
$646.46
|
|
|
DENERVATION OF HIP JOINT
|
Facility
|
OP
|
$2,368.00
|
|
|
Service Code
|
CPT 27035
|
| Hospital Charge Code |
6127035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$646.46 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,420.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,420.80
|
| Rate for Payer: Cash Price |
$1,420.80
|
| Rate for Payer: Cigna Commercial |
$2,012.80
|
| Rate for Payer: First Health Commercial |
$2,131.20
|
| Rate for Payer: First Health Workers Compensation |
$914.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,131.20
|
| Rate for Payer: GEHA Commercial |
$1,894.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,131.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,154.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,657.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,131.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,249.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,202.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$947.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$646.46
|
|
|
DENOSUMAB 60 MG/1 ML SUBQ INJ
|
Facility
|
OP
|
$5,138.05
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
3303198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$4,881.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,082.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$3,082.83
|
| Rate for Payer: Cash Price |
$3,082.83
|
| Rate for Payer: Cigna Commercial |
$4,367.34
|
| Rate for Payer: First Health Commercial |
$4,624.24
|
| Rate for Payer: First Health Workers Compensation |
$1,983.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,624.24
|
| Rate for Payer: GEHA Commercial |
$32.32
|
| Rate for Payer: GEHA Medicare |
$29.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,624.24
|
| Rate for Payer: Humana ChoiceCare |
$32.32
|
| Rate for Payer: Humana Medicare Advantage |
$29.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.38
|
| Rate for Payer: Multiplan All |
$4,675.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.95
|
| Rate for Payer: OMNI Networks Commercial |
$3,596.64
|
| Rate for Payer: One Health Plan PPO/POS |
$4,624.24
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,881.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$58.76
|
| Rate for Payer: Three Rivers Provider Network All |
$3,853.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,778.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.38
|
| Rate for Payer: Zelis Auto |
$2,055.22
|
| Rate for Payer: Zelis Medicare |
$24.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.26
|
| Rate for Payer: Zelis Worker's Compensation |
$1,402.69
|
|
|
DENOSUMAB 60 MG/1 ML SUBQ INJ
|
Facility
|
IP
|
$5,138.05
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
3303198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,402.69 |
| Max. Negotiated Rate |
$4,881.15 |
| Rate for Payer: Cash Price |
$3,082.83
|
| Rate for Payer: Cigna Commercial |
$4,367.34
|
| Rate for Payer: First Health Commercial |
$4,624.24
|
| Rate for Payer: First Health Workers Compensation |
$1,983.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,624.24
|
| Rate for Payer: GEHA Commercial |
$3,596.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,624.24
|
| Rate for Payer: Multiplan All |
$4,675.63
|
| Rate for Payer: OMNI Networks Commercial |
$3,596.64
|
| Rate for Payer: One Health Plan PPO/POS |
$4,624.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,881.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,853.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,778.39
|
| Rate for Payer: Zelis Auto |
$2,055.22
|
| Rate for Payer: Zelis Worker's Compensation |
$1,402.69
|
|
|
DENSE DONE DRILL
|
Facility
|
OP
|
$501.00
|
|
| Hospital Charge Code |
90070016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$400.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Humana ChoiceCare |
$130.26
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$300.60
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$440.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$250.50
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
|
DENSE DONE DRILL
|
Facility
|
IP
|
$501.00
|
|
| Hospital Charge Code |
90070016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.77 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$350.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
