|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
8711740
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
6111740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$37.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$67.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Worker's Compensation |
$26.48
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$156.21
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
8511740
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$148.40 |
| Rate for Payer: Cash Price |
$93.73
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$140.59
|
| Rate for Payer: First Health Workers Compensation |
$60.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.59
|
| Rate for Payer: GEHA Commercial |
$109.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.59
|
| Rate for Payer: Multiplan All |
$142.15
|
| Rate for Payer: OMNI Networks Commercial |
$109.35
|
| Rate for Payer: One Health Plan PPO/POS |
$140.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.40
|
| Rate for Payer: Three Rivers Provider Network All |
$117.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.28
|
| Rate for Payer: Zelis Auto |
$62.48
|
| Rate for Payer: Zelis Worker's Compensation |
$42.65
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
20300022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$156.21
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
8511740
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$93.73
|
| Rate for Payer: Cash Price |
$93.73
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$140.59
|
| Rate for Payer: First Health Workers Compensation |
$60.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.59
|
| Rate for Payer: GEHA Commercial |
$124.97
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.59
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$142.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$109.35
|
| Rate for Payer: One Health Plan PPO/POS |
$140.59
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$117.16
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$62.48
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$42.65
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
8300016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
21600084
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$37.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$67.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Worker's Compensation |
$26.48
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9611740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$434.40
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
EVENT MONITOR RECORD
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
4009012
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
EVENT MONITOR RECORD
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
4009012
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.13
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: GEHA Medicare |
$36.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Humana ChoiceCare |
$39.74
|
| Rate for Payer: Humana Medicare Advantage |
$36.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.13
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.42
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.26
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.41
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.13
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Medicare |
$30.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.36
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
everolimus whole blood REF 700003
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
2232168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$24.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.22
|
|
|
everolimus whole blood REF 700003
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
2232168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$24.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: GEHA Medicare |
$13.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$15.10
|
| Rate for Payer: Humana Medicare Advantage |
$13.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.73
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.34
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.46
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$223.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.73
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Medicare |
$11.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.48
|
| Rate for Payer: Zelis Worker's Compensation |
$17.22
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
6156821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$97.46 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$294.75
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$303.45
|
| Rate for Payer: First Health Commercial |
$321.30
|
| Rate for Payer: First Health Workers Compensation |
$137.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$321.30
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: GEHA Medicare |
$294.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$321.30
|
| Rate for Payer: Humana ChoiceCare |
$324.23
|
| Rate for Payer: Humana Medicare Advantage |
$294.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$495.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$294.75
|
| Rate for Payer: Multiplan All |
$324.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$501.07
|
| Rate for Payer: OMNI Networks Commercial |
$249.90
|
| Rate for Payer: One Health Plan PPO/POS |
$321.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$294.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$339.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$589.50
|
| Rate for Payer: Three Rivers Provider Network All |
$267.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$288.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$294.75
|
| Rate for Payer: Zelis Auto |
$142.80
|
| Rate for Payer: Zelis Medicare |
$250.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$353.70
|
| Rate for Payer: Zelis Worker's Compensation |
$97.46
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
6156821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$97.46 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$303.45
|
| Rate for Payer: First Health Commercial |
$321.30
|
| Rate for Payer: First Health Workers Compensation |
$137.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$321.30
|
| Rate for Payer: GEHA Commercial |
$249.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$321.30
|
| Rate for Payer: Multiplan All |
$324.87
|
| Rate for Payer: OMNI Networks Commercial |
$249.90
|
| Rate for Payer: One Health Plan PPO/POS |
$321.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$339.15
|
| Rate for Payer: Three Rivers Provider Network All |
$267.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.01
|
| Rate for Payer: Zelis Auto |
$142.80
|
| Rate for Payer: Zelis Worker's Compensation |
$97.46
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
6157420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$273.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$294.75
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: GEHA Medicare |
$294.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$324.23
|
| Rate for Payer: Humana Medicare Advantage |
$294.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$495.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$278.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$294.75
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$501.07
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$321.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$278.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$294.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$589.50
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$288.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$294.75
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Medicare |
$250.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$353.70
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
6157420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
EXAM OF VULVA W/SCOPE
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
6156820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$188.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
EXAM OF VULVA W/SCOPE
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
6156820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$389.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$161.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$194.93
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$215.20
|
| Rate for Payer: GEHA Medicare |
$194.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Humana ChoiceCare |
$214.42
|
| Rate for Payer: Humana Medicare Advantage |
$194.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$327.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$194.93
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.38
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$194.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$389.86
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$191.03
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$194.93
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Medicare |
$165.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.92
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
EX ARM/ELBOW TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
6124076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Worker's Compensation |
$304.39
|
|
|
EX ARM/ELBOW TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
6124076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$5,546.54 |
| 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 |
$669.00
|
| 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 |
$2,773.27
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| 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 |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$304.39
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
6124073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.39 |
| Max. Negotiated Rate |
$1,358.50 |
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cigna Commercial |
$1,215.50
|
| Rate for Payer: First Health Commercial |
$1,287.00
|
| Rate for Payer: First Health Workers Compensation |
$552.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,287.00
|
| Rate for Payer: GEHA Commercial |
$1,001.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,287.00
|
| Rate for Payer: Multiplan All |
$1,301.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,001.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,287.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,358.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,072.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,329.90
|
| Rate for Payer: Zelis Auto |
$572.00
|
| Rate for Payer: Zelis Worker's Compensation |
$390.39
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
6124073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.39 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$858.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cigna Commercial |
$1,215.50
|
| Rate for Payer: First Health Commercial |
$1,287.00
|
| Rate for Payer: First Health Workers Compensation |
$552.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,287.00
|
| Rate for Payer: GEHA Commercial |
$1,144.00
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,287.00
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,301.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,001.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,287.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,358.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,329.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$572.00
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$390.39
|
|
|
EXC ABD LES SC < 3 CM
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 22902
|
| Hospital Charge Code |
6122902
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$3,139.96 |
| 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 |
$511.20
|
| 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 |
$1,569.98
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$681.60
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
EXC ABD LES SC < 3 CM
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 22902
|
| Hospital Charge Code |
6122902
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
EXC ABD LES SC 3 CM/>
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
CPT 22903
|
| Hospital Charge Code |
6122903
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.43 |
| Max. Negotiated Rate |
$864.50 |
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$773.50
|
| Rate for Payer: First Health Commercial |
$819.00
|
| Rate for Payer: First Health Workers Compensation |
$351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.00
|
| Rate for Payer: GEHA Commercial |
$637.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.00
|
| Rate for Payer: Multiplan All |
$828.10
|
| Rate for Payer: OMNI Networks Commercial |
$637.00
|
| Rate for Payer: One Health Plan PPO/POS |
$819.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$864.50
|
| Rate for Payer: Three Rivers Provider Network All |
$682.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$846.30
|
| Rate for Payer: Zelis Auto |
$364.00
|
| Rate for Payer: Zelis Worker's Compensation |
$248.43
|
|
