|
EXC H-F-NK-SP MLG+MARG 0.5<
|
Facility
|
IP
|
$6,212.00
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
20311620
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,695.88 |
| Max. Negotiated Rate |
$5,901.40 |
| Rate for Payer: Cash Price |
$3,727.20
|
| Rate for Payer: Cigna Commercial |
$5,280.20
|
| Rate for Payer: First Health Commercial |
$5,590.80
|
| Rate for Payer: First Health Workers Compensation |
$2,398.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,590.80
|
| Rate for Payer: GEHA Commercial |
$4,348.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,590.80
|
| Rate for Payer: Multiplan All |
$5,652.92
|
| Rate for Payer: OMNI Networks Commercial |
$4,348.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,590.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,901.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,659.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,777.16
|
| Rate for Payer: Zelis Auto |
$2,484.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,695.88
|
|
|
EXC H-F-NK-SP MLG+MARG 1.1-2
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
6111622
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$315.60
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$447.10
|
| Rate for Payer: First Health Commercial |
$473.40
|
| Rate for Payer: First Health Workers Compensation |
$203.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$473.40
|
| Rate for Payer: GEHA Commercial |
$420.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$499.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$489.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$143.60
|
|
|
EXC H-F-NK-SP MLG+MARG 1.1-2
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
6111622
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$447.10
|
| Rate for Payer: First Health Commercial |
$473.40
|
| Rate for Payer: First Health Workers Compensation |
$203.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$473.40
|
| Rate for Payer: GEHA Commercial |
$368.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$499.70
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$489.18
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Worker's Compensation |
$143.60
|
|
|
EXC H-F-NK-SP MLG+MARG 2.1-3
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
6111623
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| 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 |
$326.40
|
| 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 |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$210.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$435.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| 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 |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| 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 |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| 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 |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$217.60
|
| 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 |
$148.51
|
|
|
EXC H-F-NK-SP MLG+MARG 2.1-3
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
6111623
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$210.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$380.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Worker's Compensation |
$148.51
|
|
|
EXC H-F-NK-SP MLG+MARG 3.1-4
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 11624
|
| Hospital Charge Code |
6111624
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.71 |
| 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 |
$370.80
|
| 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 |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$494.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| 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 |
$562.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| 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 |
$587.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| 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 |
$574.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$247.20
|
| 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 |
$168.71
|
|
|
EXC H-F-NK-SP MLG+MARG 3.1-4
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 11624
|
| Hospital Charge Code |
6111624
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$587.10 |
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$432.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| Rate for Payer: Multiplan All |
$562.38
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$587.10
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$574.74
|
| Rate for Payer: Zelis Auto |
$247.20
|
| Rate for Payer: Zelis Worker's Compensation |
$168.71
|
|
|
EXC HIP PELVIS LES SC 3 CM/>
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 27043
|
| Hospital Charge Code |
6127043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.90 |
| Max. Negotiated Rate |
$925.30 |
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$827.90
|
| Rate for Payer: First Health Commercial |
$876.60
|
| Rate for Payer: First Health Workers Compensation |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$681.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| Rate for Payer: Multiplan All |
$886.34
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$925.30
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$905.82
|
| Rate for Payer: Zelis Auto |
$389.60
|
| Rate for Payer: Zelis Worker's Compensation |
$265.90
|
|
|
EXC HIP PELVIS LES SC 3 CM/>
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 27043
|
| Hospital Charge Code |
6127043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.90 |
| 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 |
$584.40
|
| 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 |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$827.90
|
| Rate for Payer: First Health Commercial |
$876.60
|
| Rate for Payer: First Health Workers Compensation |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$779.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| 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 |
$886.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| 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 |
$925.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| 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 |
$905.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$389.60
|
| 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 |
$265.90
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
6127047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.16 |
| Max. Negotiated Rate |
$884.45 |
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$791.35
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: First Health Workers Compensation |
$359.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.90
|
| Rate for Payer: GEHA Commercial |
$651.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.90
|
| Rate for Payer: Multiplan All |
$847.21
|
| Rate for Payer: OMNI Networks Commercial |
$651.70
|
| Rate for Payer: One Health Plan PPO/POS |
$837.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$884.45
|
| Rate for Payer: Three Rivers Provider Network All |
$698.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$865.83
|
| Rate for Payer: Zelis Auto |
$372.40
|
| Rate for Payer: Zelis Worker's Compensation |
$254.16
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
6127047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.16 |
| 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 |
$558.60
|
| 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 |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$791.35
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: First Health Workers Compensation |
$359.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.90
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.90
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$847.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$651.70
|
| Rate for Payer: One Health Plan PPO/POS |
$837.90
|
| 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 |
$884.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$698.25
|
| 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 |
$865.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$372.40
|
| 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 |
$254.16
|
|
|
EXC HIP/PELV TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 27048
|
| Hospital Charge Code |
6127048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$1,199.85 |
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: First Health Workers Compensation |
$487.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$884.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| Rate for Payer: Multiplan All |
$1,149.33
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,199.85
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,174.59
|
| Rate for Payer: Zelis Auto |
$505.20
|
| Rate for Payer: Zelis Worker's Compensation |
$344.80
|
|
|
EXC HIP/PELV TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 27048
|
| Hospital Charge Code |
6127048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$344.80 |
| 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 |
$757.80
|
| 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 |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: First Health Workers Compensation |
$487.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$1,010.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| 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 |
$1,149.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| 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 |
$1,199.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| 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 |
$1,174.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$505.20
|
| 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 |
$344.80
|
|
|
EXC HIP/PELV TUM DEEP 5 CM/>
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 27045
|
| Hospital Charge Code |
6127045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$423.42 |
| Max. Negotiated Rate |
$1,473.45 |
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$1,318.35
|
| Rate for Payer: First Health Commercial |
$1,395.90
|
| Rate for Payer: First Health Workers Compensation |
$598.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,395.90
|
| Rate for Payer: GEHA Commercial |
$1,085.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,395.90
|
| Rate for Payer: Multiplan All |
$1,411.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,085.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,395.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,473.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,163.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,442.43
|
| Rate for Payer: Zelis Auto |
$620.40
|
| Rate for Payer: Zelis Worker's Compensation |
$423.42
|
|
|
EXC HIP/PELV TUM DEEP 5 CM/>
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 27045
|
| Hospital Charge Code |
6127045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$423.42 |
| 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 |
$930.60
|
| 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 |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$1,318.35
|
| Rate for Payer: First Health Commercial |
$1,395.90
|
| Rate for Payer: First Health Workers Compensation |
$598.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,395.90
|
| Rate for Payer: GEHA Commercial |
$1,240.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,395.90
|
| 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 |
$1,411.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,085.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,395.90
|
| 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 |
$1,473.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,163.25
|
| 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 |
$1,442.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$620.40
|
| 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 |
$423.42
|
|
|
EXCISE ANAL EXT TAG/PAPILLA
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
6146220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$140.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$292.00
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$99.64
|
|
|
EXCISE ANAL EXT TAG/PAPILLA
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
6146220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$140.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$255.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$99.64
|
|
|
EXCISE BREAST DUCT FISTULA
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 19112
|
| Hospital Charge Code |
6119112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$216.76 |
| Max. Negotiated Rate |
$7,272.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: First Health Workers Compensation |
$306.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$216.76
|
|
|
EXCISE BREAST DUCT FISTULA
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 19112
|
| Hospital Charge Code |
6119112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$216.76 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: First Health Workers Compensation |
$306.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Worker's Compensation |
$216.76
|
|
|
EXCISE EPIPHYSEAL BAR
|
Facility
|
OP
|
$1,863.00
|
|
|
Service Code
|
CPT 20150
|
| Hospital Charge Code |
6120150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$508.60 |
| 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 |
$1,117.80
|
| 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 |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cigna Commercial |
$1,583.55
|
| Rate for Payer: First Health Commercial |
$1,676.70
|
| Rate for Payer: First Health Workers Compensation |
$719.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,676.70
|
| Rate for Payer: GEHA Commercial |
$1,490.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,676.70
|
| 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 |
$1,695.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,304.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,676.70
|
| 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 |
$1,769.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,397.25
|
| 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 |
$1,732.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$745.20
|
| 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 |
$508.60
|
|
|
EXCISE EPIPHYSEAL BAR
|
Facility
|
IP
|
$1,863.00
|
|
|
Service Code
|
CPT 20150
|
| Hospital Charge Code |
6120150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$508.60 |
| Max. Negotiated Rate |
$1,769.85 |
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cigna Commercial |
$1,583.55
|
| Rate for Payer: First Health Commercial |
$1,676.70
|
| Rate for Payer: First Health Workers Compensation |
$719.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,676.70
|
| Rate for Payer: GEHA Commercial |
$1,304.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,676.70
|
| Rate for Payer: Multiplan All |
$1,695.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,304.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,676.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,769.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,397.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,732.59
|
| Rate for Payer: Zelis Auto |
$745.20
|
| Rate for Payer: Zelis Worker's Compensation |
$508.60
|
|
|
EXCISE EXCESSIVE SKIN LEG
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 15833
|
| Hospital Charge Code |
6115833
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$439.00 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,053.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: First Health Workers Compensation |
$677.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,404.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| 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 Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$439.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$702.40
|
| 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 |
$479.39
|
|
|
EXCISE EXCESSIVE SKIN LEG
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 15833
|
| Hospital Charge Code |
6115833
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$479.39 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: First Health Workers Compensation |
$677.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,229.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
| Rate for Payer: Zelis Worker's Compensation |
$479.39
|
|
|
EXCISE FOOT TENDON SHEATH
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 28088
|
| Hospital Charge Code |
6128088
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.29 |
| Max. Negotiated Rate |
$683.05 |
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$277.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$503.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Worker's Compensation |
$196.29
|
|
|
EXCISE FOOT TENDON SHEATH
|
Facility
|
IP
|
$1,490.22
|
|
|
Service Code
|
CPT 28086
|
| Hospital Charge Code |
6128086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.83 |
| Max. Negotiated Rate |
$1,415.71 |
| Rate for Payer: Cash Price |
$894.13
|
| Rate for Payer: Cigna Commercial |
$1,266.69
|
| Rate for Payer: First Health Commercial |
$1,341.20
|
| Rate for Payer: First Health Workers Compensation |
$575.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,341.20
|
| Rate for Payer: GEHA Commercial |
$1,043.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,341.20
|
| Rate for Payer: Multiplan All |
$1,356.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,043.15
|
| Rate for Payer: One Health Plan PPO/POS |
$1,341.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,415.71
|
| Rate for Payer: Three Rivers Provider Network All |
$1,117.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,385.90
|
| Rate for Payer: Zelis Auto |
$596.09
|
| Rate for Payer: Zelis Worker's Compensation |
$406.83
|
|
