|
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
|
|
|
EXC ABDL TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
CPT 22900
|
| Hospital Charge Code |
6122900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 |
$702.60
|
| 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 |
$2,717.63
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$936.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$468.40
|
| 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 |
$319.68
|
|
|
EXC ABDL TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
CPT 22900
|
| Hospital Charge Code |
6122900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$1,112.45 |
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$819.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
EXC ABDL TUM DEEP 5 CM/>
|
Facility
|
IP
|
$1,382.00
|
|
|
Service Code
|
CPT 22901
|
| Hospital Charge Code |
6122901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.29 |
| Max. Negotiated Rate |
$1,312.90 |
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$1,174.70
|
| Rate for Payer: First Health Commercial |
$1,243.80
|
| Rate for Payer: First Health Workers Compensation |
$533.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,243.80
|
| Rate for Payer: GEHA Commercial |
$967.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,243.80
|
| Rate for Payer: Multiplan All |
$1,257.62
|
| Rate for Payer: OMNI Networks Commercial |
$967.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,243.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,312.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,036.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,285.26
|
| Rate for Payer: Zelis Auto |
$552.80
|
| Rate for Payer: Zelis Worker's Compensation |
$377.29
|
|
|
EXC ABDL TUM DEEP 5 CM/>
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 22901
|
| Hospital Charge Code |
6122901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.29 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 |
$829.20
|
| 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 |
$2,717.63
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$1,174.70
|
| Rate for Payer: First Health Commercial |
$1,243.80
|
| Rate for Payer: First Health Workers Compensation |
$533.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,243.80
|
| Rate for Payer: GEHA Commercial |
$1,105.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,243.80
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,257.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$967.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,243.80
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,312.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,036.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,285.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$552.80
|
| 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 |
$377.29
|
|
|
EXC ABD TUM 5 CM OR LESS
|
Facility
|
IP
|
$2,513.00
|
|
|
Service Code
|
CPT 49203
|
| Hospital Charge Code |
6149203
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$686.05 |
| Max. Negotiated Rate |
$2,387.35 |
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$2,136.05
|
| Rate for Payer: First Health Commercial |
$2,261.70
|
| Rate for Payer: First Health Workers Compensation |
$970.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,261.70
|
| Rate for Payer: GEHA Commercial |
$1,759.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,261.70
|
| Rate for Payer: Multiplan All |
$2,286.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,759.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,261.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,387.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,884.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,337.09
|
| Rate for Payer: Zelis Auto |
$1,005.20
|
| Rate for Payer: Zelis Worker's Compensation |
$686.05
|
|
|
EXC ABD TUM 5 CM OR LESS
|
Facility
|
OP
|
$2,513.00
|
|
|
Service Code
|
CPT 49203
|
| Hospital Charge Code |
6149203
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$628.25 |
| Max. Negotiated Rate |
$2,387.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,507.80
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$2,136.05
|
| Rate for Payer: First Health Commercial |
$2,261.70
|
| Rate for Payer: First Health Workers Compensation |
$970.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,261.70
|
| Rate for Payer: GEHA Commercial |
$2,010.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,261.70
|
| Rate for Payer: Humana ChoiceCare |
$653.38
|
| Rate for Payer: Multiplan All |
$2,286.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,507.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,759.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,261.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,387.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,884.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,211.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$628.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,337.09
|
| Rate for Payer: Zelis Auto |
$1,005.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,256.50
|
| Rate for Payer: Zelis Worker's Compensation |
$686.05
|
|
|
EXC ABD TUM OVER 10 CM
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
CPT 49205
|
| Hospital Charge Code |
6149205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$925.00 |
| Max. Negotiated Rate |
$3,515.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: First Health Commercial |
$3,330.00
|
| Rate for Payer: First Health Workers Compensation |
$1,428.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,330.00
|
| Rate for Payer: GEHA Commercial |
$2,960.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,330.00
|
| Rate for Payer: Humana ChoiceCare |
$962.00
|
| Rate for Payer: Multiplan All |
$3,367.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,220.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,590.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,330.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,515.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,775.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,256.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$925.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,441.00
|
| Rate for Payer: Zelis Auto |
$1,480.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,850.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,010.10
|
|
|
EXC ABD TUM OVER 10 CM
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
CPT 49205
|
| Hospital Charge Code |
6149205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,010.10 |
| Max. Negotiated Rate |
$3,515.00 |
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: First Health Commercial |
$3,330.00
|
| Rate for Payer: First Health Workers Compensation |
$1,428.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,330.00
|
| Rate for Payer: GEHA Commercial |
$2,590.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,330.00
|
| Rate for Payer: Multiplan All |
$3,367.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,590.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,330.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,515.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,775.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,441.00
|
| Rate for Payer: Zelis Auto |
$1,480.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,010.10
|
|
|
EXC ABD TUM OVER 5 CM
|
Facility
|
OP
|
$3,219.00
|
|
|
Service Code
|
CPT 49204
|
| Hospital Charge Code |
6149204
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$804.75 |
| Max. Negotiated Rate |
$3,058.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,931.40
|
| Rate for Payer: Cigna Commercial |
$2,736.15
|
| Rate for Payer: First Health Commercial |
$2,897.10
|
| Rate for Payer: First Health Workers Compensation |
$1,242.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,897.10
|
| Rate for Payer: GEHA Commercial |
$2,575.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,897.10
|
| Rate for Payer: Humana ChoiceCare |
$836.94
|
| Rate for Payer: Multiplan All |
$2,929.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,931.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,253.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,897.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,058.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,414.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,832.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$804.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,993.67
|
| Rate for Payer: Zelis Auto |
$1,287.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,609.50
|
| Rate for Payer: Zelis Worker's Compensation |
$878.79
|
|
|
EXC ABD TUM OVER 5 CM
|
Facility
|
IP
|
$3,219.00
|
|
|
Service Code
|
CPT 49204
|
| Hospital Charge Code |
6149204
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$878.79 |
| Max. Negotiated Rate |
$3,058.05 |
| Rate for Payer: Cash Price |
$1,931.40
|
| Rate for Payer: Cigna Commercial |
$2,736.15
|
| Rate for Payer: First Health Commercial |
$2,897.10
|
| Rate for Payer: First Health Workers Compensation |
$1,242.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,897.10
|
| Rate for Payer: GEHA Commercial |
$2,253.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,897.10
|
| Rate for Payer: Multiplan All |
$2,929.29
|
| Rate for Payer: OMNI Networks Commercial |
$2,253.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,897.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,058.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,414.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,993.67
|
| Rate for Payer: Zelis Auto |
$1,287.60
|
| Rate for Payer: Zelis Worker's Compensation |
$878.79
|
|
|
EXC ARM/ELBOW LES SC < 3 CM
|
Facility
|
OP
|
$5,248.10
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
20324075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$4,985.69 |
| 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 |
$3,148.86
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,148.86
|
| Rate for Payer: Cash Price |
$3,148.86
|
| Rate for Payer: Cigna Commercial |
$4,460.89
|
| Rate for Payer: First Health Commercial |
$4,723.29
|
| Rate for Payer: First Health Workers Compensation |
$2,026.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,723.29
|
| Rate for Payer: GEHA Commercial |
$4,198.48
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,723.29
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$4,775.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,673.67
|
| Rate for Payer: One Health Plan PPO/POS |
$4,723.29
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,985.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,936.07
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,880.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,099.24
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,432.73
|
|
|
EXC ARM/ELBOW LES SC < 3 CM
|
Facility
|
IP
|
$5,248.10
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
20324075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,432.73 |
| Max. Negotiated Rate |
$4,985.69 |
| Rate for Payer: Cash Price |
$3,148.86
|
| Rate for Payer: Cigna Commercial |
$4,460.89
|
| Rate for Payer: First Health Commercial |
$4,723.29
|
| Rate for Payer: First Health Workers Compensation |
$2,026.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,723.29
|
| Rate for Payer: GEHA Commercial |
$3,673.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,723.29
|
| Rate for Payer: Multiplan All |
$4,775.77
|
| Rate for Payer: OMNI Networks Commercial |
$3,673.67
|
| Rate for Payer: One Health Plan PPO/POS |
$4,723.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,985.69
|
| Rate for Payer: Three Rivers Provider Network All |
$3,936.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,880.73
|
| Rate for Payer: Zelis Auto |
$2,099.24
|
| Rate for Payer: Zelis Worker's Compensation |
$1,432.73
|
|
|
EXC ARM/ELBOW LES SC < 3 CM
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
6124075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$717.40
|
| Rate for Payer: First Health Commercial |
$759.60
|
| Rate for Payer: First Health Workers Compensation |
$325.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$759.60
|
| Rate for Payer: GEHA Commercial |
$590.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$759.60
|
| Rate for Payer: Multiplan All |
$768.04
|
| Rate for Payer: OMNI Networks Commercial |
$590.80
|
| Rate for Payer: One Health Plan PPO/POS |
$759.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$801.80
|
| Rate for Payer: Three Rivers Provider Network All |
$633.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$784.92
|
| Rate for Payer: Zelis Auto |
$337.60
|
| Rate for Payer: Zelis Worker's Compensation |
$230.41
|
|
|
EXC ARM/ELBOW LES SC < 3 CM
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
6124075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$506.40
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$717.40
|
| Rate for Payer: First Health Commercial |
$759.60
|
| Rate for Payer: First Health Workers Compensation |
$325.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$759.60
|
| Rate for Payer: GEHA Commercial |
$675.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$759.60
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$768.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$590.80
|
| Rate for Payer: One Health Plan PPO/POS |
$759.60
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$801.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$633.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$784.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$337.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$230.41
|
|
|
EXC ARM/ELBOW LES SC 3 CM/>
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 24071
|
| Hospital Charge Code |
6124071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$586.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
EXC ARM/ELBOW LES SC 3 CM/>
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 24071
|
| Hospital Charge Code |
6124071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 |
$502.80
|
| 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 |
$2,717.63
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$670.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$335.20
|
| 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 |
$228.77
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9400021
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$454.75
|
| Rate for Payer: First Health Commercial |
$481.50
|
| Rate for Payer: First Health Workers Compensation |
$206.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$481.50
|
| Rate for Payer: GEHA Commercial |
$374.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$481.50
|
| Rate for Payer: Multiplan All |
$486.85
|
| Rate for Payer: OMNI Networks Commercial |
$374.50
|
| Rate for Payer: One Health Plan PPO/POS |
$481.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$508.25
|
| Rate for Payer: Three Rivers Provider Network All |
$401.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$497.55
|
| Rate for Payer: Zelis Auto |
$214.00
|
| Rate for Payer: Zelis Worker's Compensation |
$146.06
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
OP
|
$495.30
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
7211422
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cigna Commercial |
$421.00
|
| Rate for Payer: First Health Commercial |
$445.77
|
| Rate for Payer: First Health Workers Compensation |
$191.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.77
|
| Rate for Payer: GEHA Commercial |
$396.24
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.77
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$450.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$346.71
|
| Rate for Payer: One Health Plan PPO/POS |
$445.77
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$371.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$198.12
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$135.22
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
IP
|
$495.30
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
7211422
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$470.54 |
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cigna Commercial |
$421.00
|
| Rate for Payer: First Health Commercial |
$445.77
|
| Rate for Payer: First Health Workers Compensation |
$191.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.77
|
| Rate for Payer: GEHA Commercial |
$346.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.77
|
| Rate for Payer: Multiplan All |
$450.72
|
| Rate for Payer: OMNI Networks Commercial |
$346.71
|
| Rate for Payer: One Health Plan PPO/POS |
$445.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.54
|
| Rate for Payer: Three Rivers Provider Network All |
$371.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.63
|
| Rate for Payer: Zelis Auto |
$198.12
|
| Rate for Payer: Zelis Worker's Compensation |
$135.22
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
IP
|
$495.30
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
8511422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$470.54 |
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cigna Commercial |
$421.00
|
| Rate for Payer: First Health Commercial |
$445.77
|
| Rate for Payer: First Health Workers Compensation |
$191.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.77
|
| Rate for Payer: GEHA Commercial |
$346.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.77
|
| Rate for Payer: Multiplan All |
$450.72
|
| Rate for Payer: OMNI Networks Commercial |
$346.71
|
| Rate for Payer: One Health Plan PPO/POS |
$445.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.54
|
| Rate for Payer: Three Rivers Provider Network All |
$371.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.63
|
| Rate for Payer: Zelis Auto |
$198.12
|
| Rate for Payer: Zelis Worker's Compensation |
$135.22
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
OP
|
$495.30
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
6111422
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cigna Commercial |
$421.00
|
| Rate for Payer: First Health Commercial |
$445.77
|
| Rate for Payer: First Health Workers Compensation |
$191.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.77
|
| Rate for Payer: GEHA Commercial |
$396.24
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.77
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$450.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$346.71
|
| Rate for Payer: One Health Plan PPO/POS |
$445.77
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$371.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$198.12
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$135.22
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9400021
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$454.75
|
| Rate for Payer: First Health Commercial |
$481.50
|
| Rate for Payer: First Health Workers Compensation |
$206.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$481.50
|
| Rate for Payer: GEHA Commercial |
$428.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$481.50
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$486.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$374.50
|
| Rate for Payer: One Health Plan PPO/POS |
$481.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$508.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$401.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$497.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$214.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$146.06
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
IP
|
$495.30
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
6111422
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$470.54 |
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cigna Commercial |
$421.00
|
| Rate for Payer: First Health Commercial |
$445.77
|
| Rate for Payer: First Health Workers Compensation |
$191.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.77
|
| Rate for Payer: GEHA Commercial |
$346.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.77
|
| Rate for Payer: Multiplan All |
$450.72
|
| Rate for Payer: OMNI Networks Commercial |
$346.71
|
| Rate for Payer: One Health Plan PPO/POS |
$445.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.54
|
| Rate for Payer: Three Rivers Provider Network All |
$371.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.63
|
| Rate for Payer: Zelis Auto |
$198.12
|
| Rate for Payer: Zelis Worker's Compensation |
$135.22
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G1.1-2
|
Facility
|
OP
|
$495.30
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
8511422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cash Price |
$297.18
|
| Rate for Payer: Cigna Commercial |
$421.00
|
| Rate for Payer: First Health Commercial |
$445.77
|
| Rate for Payer: First Health Workers Compensation |
$191.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.77
|
| Rate for Payer: GEHA Commercial |
$396.24
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.77
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$450.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$346.71
|
| Rate for Payer: One Health Plan PPO/POS |
$445.77
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$371.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$198.12
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$135.22
|
|
