|
EXPLORATION OF FOOT JOINT
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT 28022
|
| Hospital Charge Code |
6128022
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.04 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$496.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$319.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$662.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$331.20
|
| 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 |
$226.04
|
|
|
EXPLORATION OF FOOT JOINT
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 28022
|
| Hospital Charge Code |
6128022
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.04 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$319.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$579.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Worker's Compensation |
$226.04
|
|
|
EXPLORATION OF FRONTAL SINUS
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
CPT 31075
|
| Hospital Charge Code |
6131075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.70 |
| Max. Negotiated Rate |
$1,505.75 |
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$1,347.25
|
| Rate for Payer: First Health Commercial |
$1,426.50
|
| Rate for Payer: First Health Workers Compensation |
$611.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,426.50
|
| Rate for Payer: GEHA Commercial |
$1,109.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,426.50
|
| Rate for Payer: Multiplan All |
$1,442.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,109.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,426.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,505.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,188.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.05
|
| Rate for Payer: Zelis Auto |
$634.00
|
| Rate for Payer: Zelis Worker's Compensation |
$432.70
|
|
|
EXPLORATION OF FRONTAL SINUS
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
CPT 31075
|
| Hospital Charge Code |
6131075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.70 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$951.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$1,347.25
|
| Rate for Payer: First Health Commercial |
$1,426.50
|
| Rate for Payer: First Health Workers Compensation |
$611.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,426.50
|
| Rate for Payer: GEHA Commercial |
$1,268.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,426.50
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,442.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,109.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,426.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,505.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,188.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$634.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$432.70
|
|
|
EXPLORATION OF FRONTAL SINUS
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 31070
|
| Hospital Charge Code |
6131070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$527.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$703.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
EXPLORATION OF FRONTAL SINUS
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 31070
|
| Hospital Charge Code |
6131070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$615.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
EXPLORATION OF MIDDLE EAR
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 69440
|
| Hospital Charge Code |
6169440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.38 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$838.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$1,187.45
|
| Rate for Payer: First Health Commercial |
$1,257.30
|
| Rate for Payer: First Health Workers Compensation |
$539.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,257.30
|
| Rate for Payer: GEHA Commercial |
$1,117.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,257.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,271.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$977.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,257.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,327.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,299.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$558.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$381.38
|
|
|
EXPLORATION OF MIDDLE EAR
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 69440
|
| Hospital Charge Code |
6169440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.38 |
| Max. Negotiated Rate |
$1,327.15 |
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$1,187.45
|
| Rate for Payer: First Health Commercial |
$1,257.30
|
| Rate for Payer: First Health Workers Compensation |
$539.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,257.30
|
| Rate for Payer: GEHA Commercial |
$977.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,257.30
|
| Rate for Payer: Multiplan All |
$1,271.27
|
| Rate for Payer: OMNI Networks Commercial |
$977.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,257.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,327.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,299.21
|
| Rate for Payer: Zelis Auto |
$558.80
|
| Rate for Payer: Zelis Worker's Compensation |
$381.38
|
|
|
EXPLORATION OF SINUSES
|
Facility
|
IP
|
$2,053.00
|
|
|
Service Code
|
CPT 31090
|
| Hospital Charge Code |
6131090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$560.47 |
| Max. Negotiated Rate |
$1,950.35 |
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$1,745.05
|
| Rate for Payer: First Health Commercial |
$1,847.70
|
| Rate for Payer: First Health Workers Compensation |
$792.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,847.70
|
| Rate for Payer: GEHA Commercial |
$1,437.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,847.70
|
| Rate for Payer: Multiplan All |
$1,868.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,437.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,847.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,950.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,539.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,909.29
|
| Rate for Payer: Zelis Auto |
$821.20
|
| Rate for Payer: Zelis Worker's Compensation |
$560.47
|
|
|
EXPLORATION OF SINUSES
|
Facility
|
OP
|
$2,053.00
|
|
|
Service Code
|
CPT 31090
|
| Hospital Charge Code |
6131090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$560.47 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,231.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$1,745.05
|
| Rate for Payer: First Health Commercial |
$1,847.70
|
| Rate for Payer: First Health Workers Compensation |
$792.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,847.70
|
| Rate for Payer: GEHA Commercial |
$1,642.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,847.70
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,868.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,437.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,847.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,950.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,539.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,909.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$821.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$560.47
|
|
|
EXPLORATION OF SPINAL FUSION
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 22830
|
| Hospital Charge Code |
6122830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.28 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Cash Price |
$1,018.20
|
| Rate for Payer: Cigna Commercial |
$1,442.45
|
| Rate for Payer: First Health Commercial |
$1,527.30
|
| Rate for Payer: First Health Workers Compensation |
$655.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,527.30
|
| Rate for Payer: GEHA Commercial |
$1,187.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,527.30
|
| Rate for Payer: Multiplan All |
$1,544.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,187.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,527.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,612.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,272.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,578.21
|
| Rate for Payer: Zelis Auto |
$678.80
|
| Rate for Payer: Zelis Worker's Compensation |
$463.28
|
|
|
EXPLORATION OF SPINAL FUSION
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 22830
|
| Hospital Charge Code |
6122830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.25 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,018.20
|
| Rate for Payer: Cash Price |
$1,018.20
|
| Rate for Payer: Cigna Commercial |
$1,442.45
|
| Rate for Payer: First Health Commercial |
$1,527.30
|
| Rate for Payer: First Health Workers Compensation |
$655.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,527.30
|
| Rate for Payer: GEHA Commercial |
$1,357.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,527.30
|
| Rate for Payer: Humana ChoiceCare |
$441.22
|
| Rate for Payer: Multiplan All |
$1,544.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,187.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,527.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,612.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,272.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,493.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$424.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,578.21
|
| Rate for Payer: Zelis Auto |
$678.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$848.50
|
| Rate for Payer: Zelis Worker's Compensation |
$463.28
|
|
|
EXPLORATION OF URETER
|
Facility
|
OP
|
$1,951.00
|
|
|
Service Code
|
CPT 50600
|
| Hospital Charge Code |
6150600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.75 |
| Max. Negotiated Rate |
$1,853.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,170.60
|
| Rate for Payer: Cash Price |
$1,170.60
|
| Rate for Payer: Cigna Commercial |
$1,658.35
|
| Rate for Payer: First Health Commercial |
$1,755.90
|
| Rate for Payer: First Health Workers Compensation |
$753.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,755.90
|
| Rate for Payer: GEHA Commercial |
$1,560.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,755.90
|
| Rate for Payer: Humana ChoiceCare |
$507.26
|
| Rate for Payer: Multiplan All |
$1,775.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,170.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,365.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,755.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,853.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,463.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,716.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,814.43
|
| Rate for Payer: Zelis Auto |
$780.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$975.50
|
| Rate for Payer: Zelis Worker's Compensation |
$532.62
|
|
|
EXPLORATION OF URETER
|
Facility
|
IP
|
$1,951.00
|
|
|
Service Code
|
CPT 50600
|
| Hospital Charge Code |
6150600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$532.62 |
| Max. Negotiated Rate |
$1,853.45 |
| Rate for Payer: Cash Price |
$1,170.60
|
| Rate for Payer: Cigna Commercial |
$1,658.35
|
| Rate for Payer: First Health Commercial |
$1,755.90
|
| Rate for Payer: First Health Workers Compensation |
$753.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,755.90
|
| Rate for Payer: GEHA Commercial |
$1,365.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,755.90
|
| Rate for Payer: Multiplan All |
$1,775.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,365.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,755.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,853.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,463.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,814.43
|
| Rate for Payer: Zelis Auto |
$780.40
|
| Rate for Payer: Zelis Worker's Compensation |
$532.62
|
|
|
EXPLORATION OF VAGINA
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 57000
|
| Hospital Charge Code |
6157000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.88 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: First Health Workers Compensation |
$220.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$155.88
|
|
|
EXPLORATION OF VAGINA
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 57000
|
| Hospital Charge Code |
6157000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.88 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: First Health Workers Compensation |
$220.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Worker's Compensation |
$155.88
|
|
|
EXPLORATION/REPAIR OF RECTUM
|
Facility
|
IP
|
$3,462.00
|
|
|
Service Code
|
CPT 45563
|
| Hospital Charge Code |
6145563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$945.13 |
| Max. Negotiated Rate |
$3,288.90 |
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: Cigna Commercial |
$2,942.70
|
| Rate for Payer: First Health Commercial |
$3,115.80
|
| Rate for Payer: First Health Workers Compensation |
$1,336.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,115.80
|
| Rate for Payer: GEHA Commercial |
$2,423.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,115.80
|
| Rate for Payer: Multiplan All |
$3,150.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,423.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,115.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,288.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,596.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,219.66
|
| Rate for Payer: Zelis Auto |
$1,384.80
|
| Rate for Payer: Zelis Worker's Compensation |
$945.13
|
|
|
EXPLORATION/REPAIR OF RECTUM
|
Facility
|
OP
|
$2,338.00
|
|
|
Service Code
|
CPT 45562
|
| Hospital Charge Code |
6145562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.50 |
| Max. Negotiated Rate |
$2,221.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,402.80
|
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cigna Commercial |
$1,987.30
|
| Rate for Payer: First Health Commercial |
$2,104.20
|
| Rate for Payer: First Health Workers Compensation |
$902.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,104.20
|
| Rate for Payer: GEHA Commercial |
$1,870.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,104.20
|
| Rate for Payer: Humana ChoiceCare |
$607.88
|
| Rate for Payer: Multiplan All |
$2,127.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,402.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,636.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,104.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,221.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,753.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,057.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$584.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,174.34
|
| Rate for Payer: Zelis Auto |
$935.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,169.00
|
| Rate for Payer: Zelis Worker's Compensation |
$638.27
|
|
|
EXPLORATION/REPAIR OF RECTUM
|
Facility
|
IP
|
$2,338.00
|
|
|
Service Code
|
CPT 45562
|
| Hospital Charge Code |
6145562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.27 |
| Max. Negotiated Rate |
$2,221.10 |
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cigna Commercial |
$1,987.30
|
| Rate for Payer: First Health Commercial |
$2,104.20
|
| Rate for Payer: First Health Workers Compensation |
$902.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,104.20
|
| Rate for Payer: GEHA Commercial |
$1,636.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,104.20
|
| Rate for Payer: Multiplan All |
$2,127.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,636.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,104.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,221.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,753.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,174.34
|
| Rate for Payer: Zelis Auto |
$935.20
|
| Rate for Payer: Zelis Worker's Compensation |
$638.27
|
|
|
EXPLORATION/REPAIR OF RECTUM
|
Facility
|
OP
|
$3,462.00
|
|
|
Service Code
|
CPT 45563
|
| Hospital Charge Code |
6145563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$865.50 |
| Max. Negotiated Rate |
$3,288.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,077.20
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: Cigna Commercial |
$2,942.70
|
| Rate for Payer: First Health Commercial |
$3,115.80
|
| Rate for Payer: First Health Workers Compensation |
$1,336.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,115.80
|
| Rate for Payer: GEHA Commercial |
$2,769.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,115.80
|
| Rate for Payer: Humana ChoiceCare |
$900.12
|
| Rate for Payer: Multiplan All |
$3,150.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,077.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,423.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,115.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,288.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,596.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,046.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$865.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,219.66
|
| Rate for Payer: Zelis Auto |
$1,384.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,731.00
|
| Rate for Payer: Zelis Worker's Compensation |
$945.13
|
|
|
EXPLORATION SPHENOID SINUS
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 31050
|
| Hospital Charge Code |
6131050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.99 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$586.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$831.30
|
| Rate for Payer: First Health Commercial |
$880.20
|
| Rate for Payer: First Health Workers Compensation |
$377.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$880.20
|
| Rate for Payer: GEHA Commercial |
$782.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$880.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$889.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$684.60
|
| Rate for Payer: One Health Plan PPO/POS |
$880.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$929.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$733.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$909.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$391.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$266.99
|
|
|
EXPLORATION SPHENOID SINUS
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 31050
|
| Hospital Charge Code |
6131050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.99 |
| Max. Negotiated Rate |
$929.10 |
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$831.30
|
| Rate for Payer: First Health Commercial |
$880.20
|
| Rate for Payer: First Health Workers Compensation |
$377.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$880.20
|
| Rate for Payer: GEHA Commercial |
$684.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$880.20
|
| Rate for Payer: Multiplan All |
$889.98
|
| Rate for Payer: OMNI Networks Commercial |
$684.60
|
| Rate for Payer: One Health Plan PPO/POS |
$880.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$929.10
|
| Rate for Payer: Three Rivers Provider Network All |
$733.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$909.54
|
| Rate for Payer: Zelis Auto |
$391.20
|
| Rate for Payer: Zelis Worker's Compensation |
$266.99
|
|
|
EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,357.33
|
|
|
Service Code
|
CPT 49000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,666.80 |
| Max. Negotiated Rate |
$2,357.33 |
| Rate for Payer: First Health Workers Compensation |
$2,357.33
|
| Rate for Payer: Zelis Worker's Compensation |
$1,666.80
|
|
|
EXPLORE ADRENAL GLAND
|
Facility
|
IP
|
$2,543.00
|
|
|
Service Code
|
CPT 60545
|
| Hospital Charge Code |
6160545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$694.24 |
| Max. Negotiated Rate |
$2,415.85 |
| Rate for Payer: Cash Price |
$1,525.80
|
| Rate for Payer: Cigna Commercial |
$2,161.55
|
| Rate for Payer: First Health Commercial |
$2,288.70
|
| Rate for Payer: First Health Workers Compensation |
$981.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,288.70
|
| Rate for Payer: GEHA Commercial |
$1,780.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,288.70
|
| Rate for Payer: Multiplan All |
$2,314.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,780.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,288.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,415.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,907.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,364.99
|
| Rate for Payer: Zelis Auto |
$1,017.20
|
| Rate for Payer: Zelis Worker's Compensation |
$694.24
|
|
|
EXPLORE ADRENAL GLAND
|
Facility
|
OP
|
$2,543.00
|
|
|
Service Code
|
CPT 60545
|
| Hospital Charge Code |
6160545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$635.75 |
| Max. Negotiated Rate |
$2,415.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,525.80
|
| Rate for Payer: Cash Price |
$1,525.80
|
| Rate for Payer: Cigna Commercial |
$2,161.55
|
| Rate for Payer: First Health Commercial |
$2,288.70
|
| Rate for Payer: First Health Workers Compensation |
$981.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,288.70
|
| Rate for Payer: GEHA Commercial |
$2,034.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,288.70
|
| Rate for Payer: Humana ChoiceCare |
$661.18
|
| Rate for Payer: Multiplan All |
$2,314.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,525.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,780.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,288.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,415.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,907.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,237.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,364.99
|
| Rate for Payer: Zelis Auto |
$1,017.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,271.50
|
| Rate for Payer: Zelis Worker's Compensation |
$694.24
|
|
