|
EXC TUMOR SOFT TISS BACK/FLANK SUBQ <3CM
|
Facility
|
OP
|
$1,407.39
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
7221930
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$384.22 |
| 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 |
$844.43
|
| 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 |
$844.43
|
| Rate for Payer: Cash Price |
$844.43
|
| Rate for Payer: Cigna Commercial |
$1,196.28
|
| Rate for Payer: First Health Commercial |
$1,266.65
|
| Rate for Payer: First Health Workers Compensation |
$543.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.65
|
| Rate for Payer: GEHA Commercial |
$1,125.91
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.65
|
| 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 |
$1,280.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$985.17
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.65
|
| 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 |
$1,337.02
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.54
|
| 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 |
$1,308.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$562.96
|
| 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 |
$384.22
|
|
|
EXC TUMOR SOFT TISS BACK/FLANK SUBQ <3CM
|
Facility
|
OP
|
$1,407.39
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
8521930
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$384.22 |
| 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 |
$844.43
|
| 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 |
$844.43
|
| Rate for Payer: Cash Price |
$844.43
|
| Rate for Payer: Cigna Commercial |
$1,196.28
|
| Rate for Payer: First Health Commercial |
$1,266.65
|
| Rate for Payer: First Health Workers Compensation |
$543.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.65
|
| Rate for Payer: GEHA Commercial |
$1,125.91
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.65
|
| 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 |
$1,280.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$985.17
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.65
|
| 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 |
$1,337.02
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.54
|
| 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 |
$1,308.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$562.96
|
| 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 |
$384.22
|
|
|
EXC TUMOR SOFT TISS BACK/FLANK SUBQ <3CM
|
Facility
|
IP
|
$1,407.39
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
8521930
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$384.22 |
| Max. Negotiated Rate |
$1,337.02 |
| Rate for Payer: Cash Price |
$844.43
|
| Rate for Payer: Cigna Commercial |
$1,196.28
|
| Rate for Payer: First Health Commercial |
$1,266.65
|
| Rate for Payer: First Health Workers Compensation |
$543.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.65
|
| Rate for Payer: GEHA Commercial |
$985.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.65
|
| Rate for Payer: Multiplan All |
$1,280.72
|
| Rate for Payer: OMNI Networks Commercial |
$985.17
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,337.02
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.87
|
| Rate for Payer: Zelis Auto |
$562.96
|
| Rate for Payer: Zelis Worker's Compensation |
$384.22
|
|
|
EXC TUMOR SOFT TISS BACK/FLANK SUBQ <3CM
|
Facility
|
IP
|
$1,407.39
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
7221930
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$384.22 |
| Max. Negotiated Rate |
$1,337.02 |
| Rate for Payer: Cash Price |
$844.43
|
| Rate for Payer: Cigna Commercial |
$1,196.28
|
| Rate for Payer: First Health Commercial |
$1,266.65
|
| Rate for Payer: First Health Workers Compensation |
$543.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.65
|
| Rate for Payer: GEHA Commercial |
$985.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.65
|
| Rate for Payer: Multiplan All |
$1,280.72
|
| Rate for Payer: OMNI Networks Commercial |
$985.17
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,337.02
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.87
|
| Rate for Payer: Zelis Auto |
$562.96
|
| Rate for Payer: Zelis Worker's Compensation |
$384.22
|
|
|
EXC TUMOR SOFT TISS SHOULDER SUBQ 3 CM/>
|
Facility
|
OP
|
$122.74
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
8523071
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$73.64
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$73.64
|
| Rate for Payer: Cash Price |
$73.64
|
| Rate for Payer: Cigna Commercial |
$104.33
|
| Rate for Payer: First Health Commercial |
$110.47
|
| Rate for Payer: First Health Workers Compensation |
$47.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.47
|
| Rate for Payer: GEHA Commercial |
$98.19
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.47
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$111.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$85.92
|
| Rate for Payer: One Health Plan PPO/POS |
$110.47
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$92.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$49.10
|
| 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 |
$33.51
|
|
|
EXC TUMOR SOFT TISS SHOULDER SUBQ 3 CM/>
|
Facility
|
OP
|
$1,222.74
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
7223071
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$333.81 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$733.64
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$733.64
|
| Rate for Payer: Cash Price |
$733.64
|
| Rate for Payer: Cigna Commercial |
$1,039.33
|
| Rate for Payer: First Health Commercial |
$1,100.47
|
| Rate for Payer: First Health Workers Compensation |
$472.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.47
|
| Rate for Payer: GEHA Commercial |
$978.19
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.47
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,112.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$855.92
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.47
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$917.05
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$489.10
|
| 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 |
$333.81
|
|
|
EXC TUMOR SOFT TISS SHOULDER SUBQ 3 CM/>
|
Facility
|
IP
|
$122.74
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
8523071
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$116.60 |
| Rate for Payer: Cash Price |
$73.64
|
| Rate for Payer: Cigna Commercial |
$104.33
|
| Rate for Payer: First Health Commercial |
$110.47
|
| Rate for Payer: First Health Workers Compensation |
$47.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.47
|
| Rate for Payer: GEHA Commercial |
$85.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.47
|
| Rate for Payer: Multiplan All |
$111.69
|
| Rate for Payer: OMNI Networks Commercial |
$85.92
|
| Rate for Payer: One Health Plan PPO/POS |
$110.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.60
|
| Rate for Payer: Three Rivers Provider Network All |
$92.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.15
|
| Rate for Payer: Zelis Auto |
$49.10
|
| Rate for Payer: Zelis Worker's Compensation |
$33.51
|
|
|
EXC TUMOR SOFT TISS SHOULDER SUBQ 3 CM/>
|
Facility
|
IP
|
$1,222.74
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
7223071
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$333.81 |
| Max. Negotiated Rate |
$1,161.60 |
| Rate for Payer: Cash Price |
$733.64
|
| Rate for Payer: Cigna Commercial |
$1,039.33
|
| Rate for Payer: First Health Commercial |
$1,100.47
|
| Rate for Payer: First Health Workers Compensation |
$472.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.47
|
| Rate for Payer: GEHA Commercial |
$855.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.47
|
| Rate for Payer: Multiplan All |
$1,112.69
|
| Rate for Payer: OMNI Networks Commercial |
$855.92
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.60
|
| Rate for Payer: Three Rivers Provider Network All |
$917.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.15
|
| Rate for Payer: Zelis Auto |
$489.10
|
| Rate for Payer: Zelis Worker's Compensation |
$333.81
|
|
|
EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3C
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
20327618
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$214.03 |
| 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 |
$470.40
|
| 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 |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cigna Commercial |
$666.40
|
| Rate for Payer: First Health Commercial |
$705.60
|
| Rate for Payer: First Health Workers Compensation |
$302.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$705.60
|
| Rate for Payer: GEHA Commercial |
$627.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$705.60
|
| 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 |
$713.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$548.80
|
| Rate for Payer: One Health Plan PPO/POS |
$705.60
|
| 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 |
$744.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$588.00
|
| 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 |
$729.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$313.60
|
| 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 |
$214.03
|
|
|
EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3C
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
20327618
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$744.80 |
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cigna Commercial |
$666.40
|
| Rate for Payer: First Health Commercial |
$705.60
|
| Rate for Payer: First Health Workers Compensation |
$302.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$705.60
|
| Rate for Payer: GEHA Commercial |
$548.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$705.60
|
| Rate for Payer: Multiplan All |
$713.44
|
| Rate for Payer: OMNI Networks Commercial |
$548.80
|
| Rate for Payer: One Health Plan PPO/POS |
$705.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$744.80
|
| Rate for Payer: Three Rivers Provider Network All |
$588.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$729.12
|
| Rate for Payer: Zelis Auto |
$313.60
|
| Rate for Payer: Zelis Worker's Compensation |
$214.03
|
|
|
EXC TUM SOFT TIS BACK/FLANK SUBQ 3 CM/>
|
Facility
|
OP
|
$1,369.59
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
20321931
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$373.90 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$821.75
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$821.75
|
| Rate for Payer: Cash Price |
$821.75
|
| Rate for Payer: Cigna Commercial |
$1,164.15
|
| Rate for Payer: First Health Commercial |
$1,232.63
|
| Rate for Payer: First Health Workers Compensation |
$528.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.63
|
| Rate for Payer: GEHA Commercial |
$1,095.67
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.63
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,246.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$958.71
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.63
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.11
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.19
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$547.84
|
| 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 |
$373.90
|
|
|
EXC TUM SOFT TIS BACK/FLANK SUBQ 3 CM/>
|
Facility
|
IP
|
$1,369.59
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
20321931
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$373.90 |
| Max. Negotiated Rate |
$1,301.11 |
| Rate for Payer: Cash Price |
$821.75
|
| Rate for Payer: Cigna Commercial |
$1,164.15
|
| Rate for Payer: First Health Commercial |
$1,232.63
|
| Rate for Payer: First Health Workers Compensation |
$528.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.63
|
| Rate for Payer: GEHA Commercial |
$958.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.63
|
| Rate for Payer: Multiplan All |
$1,246.33
|
| Rate for Payer: OMNI Networks Commercial |
$958.71
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.11
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.72
|
| Rate for Payer: Zelis Auto |
$547.84
|
| Rate for Payer: Zelis Worker's Compensation |
$373.90
|
|
|
EXERCISE EQUIPMENT
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT A9300
|
| Hospital Charge Code |
8230050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$17.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Humana ChoiceCare |
$5.72
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.20
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
EXERCISE EQUIPMENT
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT A9300
|
| Hospital Charge Code |
8230050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$15.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
EXERNAL SINGLE COLUMN HEMORRHOIDECTOMY
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
6146999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$429.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$438.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$506.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$438.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$438.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$95.55
|
|
|
EXERNAL SINGLE COLUMN HEMORRHOIDECTOMY
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
6146999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$95.55
|
|
|
EX FB EXT EYE; CONJ EMBED
|
Facility
|
OP
|
$435.00
|
|
| Hospital Charge Code |
8165222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$369.75
|
| Rate for Payer: First Health Commercial |
$391.50
|
| Rate for Payer: First Health Workers Compensation |
$167.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$391.50
|
| Rate for Payer: GEHA Commercial |
$348.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$391.50
|
| Rate for Payer: Humana ChoiceCare |
$113.10
|
| Rate for Payer: Multiplan All |
$395.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.00
|
| Rate for Payer: OMNI Networks Commercial |
$304.50
|
| Rate for Payer: One Health Plan PPO/POS |
$391.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$413.25
|
| Rate for Payer: Three Rivers Provider Network All |
$326.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$382.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$404.55
|
| Rate for Payer: Zelis Auto |
$174.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$217.50
|
| Rate for Payer: Zelis Worker's Compensation |
$118.75
|
|
|
EX FB EXT EYE; CONJ EMBED
|
Facility
|
IP
|
$435.00
|
|
| Hospital Charge Code |
8165222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.75 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$369.75
|
| Rate for Payer: First Health Commercial |
$391.50
|
| Rate for Payer: First Health Workers Compensation |
$167.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$391.50
|
| Rate for Payer: GEHA Commercial |
$304.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$391.50
|
| Rate for Payer: Multiplan All |
$395.85
|
| Rate for Payer: OMNI Networks Commercial |
$304.50
|
| Rate for Payer: One Health Plan PPO/POS |
$391.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$413.25
|
| Rate for Payer: Three Rivers Provider Network All |
$326.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$404.55
|
| Rate for Payer: Zelis Auto |
$174.00
|
| Rate for Payer: Zelis Worker's Compensation |
$118.75
|
|
|
EX MAL LSN INC MRGN S/N/H/F/G 0.6/1.0 CM
|
Facility
|
OP
|
$632.58
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
8511621
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cigna Commercial |
$537.69
|
| Rate for Payer: First Health Commercial |
$569.32
|
| Rate for Payer: First Health Workers Compensation |
$244.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$569.32
|
| Rate for Payer: GEHA Commercial |
$506.06
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$569.32
|
| 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 |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$575.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$442.81
|
| Rate for Payer: One Health Plan PPO/POS |
$569.32
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$474.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$588.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$253.03
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$172.69
|
|
|
EX MAL LSN INC MRGN S/N/H/F/G 0.6/1.0 CM
|
Facility
|
IP
|
$632.58
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
8511621
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$600.95 |
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cigna Commercial |
$537.69
|
| Rate for Payer: First Health Commercial |
$569.32
|
| Rate for Payer: First Health Workers Compensation |
$244.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$569.32
|
| Rate for Payer: GEHA Commercial |
$442.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$569.32
|
| Rate for Payer: Multiplan All |
$575.65
|
| Rate for Payer: OMNI Networks Commercial |
$442.81
|
| Rate for Payer: One Health Plan PPO/POS |
$569.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.95
|
| Rate for Payer: Three Rivers Provider Network All |
$474.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$588.30
|
| Rate for Payer: Zelis Auto |
$253.03
|
| Rate for Payer: Zelis Worker's Compensation |
$172.69
|
|
|
EX MAL LSN INC MRGN S/N/H/F/G 0.6/1.0 CM
|
Facility
|
IP
|
$632.58
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
7211621
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$600.95 |
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cigna Commercial |
$537.69
|
| Rate for Payer: First Health Commercial |
$569.32
|
| Rate for Payer: First Health Workers Compensation |
$244.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$569.32
|
| Rate for Payer: GEHA Commercial |
$442.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$569.32
|
| Rate for Payer: Multiplan All |
$575.65
|
| Rate for Payer: OMNI Networks Commercial |
$442.81
|
| Rate for Payer: One Health Plan PPO/POS |
$569.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.95
|
| Rate for Payer: Three Rivers Provider Network All |
$474.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$588.30
|
| Rate for Payer: Zelis Auto |
$253.03
|
| Rate for Payer: Zelis Worker's Compensation |
$172.69
|
|
|
EX MAL LSN INC MRGN S/N/H/F/G 0.6/1.0 CM
|
Facility
|
OP
|
$632.58
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
7211621
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cigna Commercial |
$537.69
|
| Rate for Payer: First Health Commercial |
$569.32
|
| Rate for Payer: First Health Workers Compensation |
$244.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$569.32
|
| Rate for Payer: GEHA Commercial |
$506.06
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$569.32
|
| 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 |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$575.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$442.81
|
| Rate for Payer: One Health Plan PPO/POS |
$569.32
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$474.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$588.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$253.03
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$172.69
|
|
|
EXPAREL 1.3% 13.3MG/ML
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT J0666
|
| Hospital Charge Code |
3300123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$512.69 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: First Health Workers Compensation |
$725.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,314.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Worker's Compensation |
$512.69
|
|
|
EXPAREL 1.3% 13.3MG/ML
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT J0666
|
| Hospital Charge Code |
3300123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1.40
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: First Health Workers Compensation |
$725.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1.62
|
| Rate for Payer: GEHA Medicare |
$1.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Humana ChoiceCare |
$1.54
|
| Rate for Payer: Humana Medicare Advantage |
$1.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1.40
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1.40
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Medicare |
$1.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.68
|
| Rate for Payer: Zelis Worker's Compensation |
$512.69
|
|
|
EXPLORATION BEHIND ABDOMEN
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 49010
|
| Hospital Charge Code |
6149010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$536.45 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,670.25
|
| Rate for Payer: First Health Commercial |
$1,768.50
|
| Rate for Payer: First Health Workers Compensation |
$758.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,768.50
|
| Rate for Payer: GEHA Commercial |
$1,375.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,768.50
|
| Rate for Payer: Multiplan All |
$1,788.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,375.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,768.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,866.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,473.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,827.45
|
| Rate for Payer: Zelis Auto |
$786.00
|
| Rate for Payer: Zelis Worker's Compensation |
$536.45
|
|
