|
EXTENSIVE SURGERY OF THROAT
|
Facility
|
IP
|
$2,884.00
|
|
|
Service Code
|
CPT 42844
|
| Hospital Charge Code |
6142844
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$787.33 |
| Max. Negotiated Rate |
$2,739.80 |
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$2,451.40
|
| Rate for Payer: First Health Commercial |
$2,595.60
|
| Rate for Payer: First Health Workers Compensation |
$1,113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,595.60
|
| Rate for Payer: GEHA Commercial |
$2,018.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,595.60
|
| Rate for Payer: Multiplan All |
$2,624.44
|
| Rate for Payer: OMNI Networks Commercial |
$2,018.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,595.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,739.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,163.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,682.12
|
| Rate for Payer: Zelis Auto |
$1,153.60
|
| Rate for Payer: Zelis Worker's Compensation |
$787.33
|
|
|
EXTENSIVE SURGERY OF THROAT
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
CPT 42842
|
| Hospital Charge Code |
6142842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$572.75 |
| 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 |
$1,258.80
|
| 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 |
$1,258.80
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cigna Commercial |
$1,783.30
|
| Rate for Payer: First Health Commercial |
$1,888.20
|
| Rate for Payer: First Health Workers Compensation |
$810.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,888.20
|
| Rate for Payer: GEHA Commercial |
$1,678.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,888.20
|
| 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 |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,909.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,468.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,888.20
|
| 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 |
$1,993.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,573.50
|
| 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 |
$1,951.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$839.20
|
| 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 |
$572.75
|
|
|
EXTENSIVE SURGERY OF THROAT
|
Facility
|
IP
|
$4,676.00
|
|
|
Service Code
|
CPT 42845
|
| Hospital Charge Code |
6142845
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,276.55 |
| Max. Negotiated Rate |
$4,442.20 |
| Rate for Payer: Cash Price |
$2,805.60
|
| Rate for Payer: Cigna Commercial |
$3,974.60
|
| Rate for Payer: First Health Commercial |
$4,208.40
|
| Rate for Payer: First Health Workers Compensation |
$1,805.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,208.40
|
| Rate for Payer: GEHA Commercial |
$3,273.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,208.40
|
| Rate for Payer: Multiplan All |
$4,255.16
|
| Rate for Payer: OMNI Networks Commercial |
$3,273.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,208.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,442.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,507.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,348.68
|
| Rate for Payer: Zelis Auto |
$1,870.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,276.55
|
|
|
EXTENSIVE TESTIS SURGERY
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
CPT 54535
|
| Hospital Charge Code |
6154535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.96 |
| Max. Negotiated Rate |
$1,454.45 |
| Rate for Payer: Cash Price |
$918.60
|
| Rate for Payer: Cigna Commercial |
$1,301.35
|
| Rate for Payer: First Health Commercial |
$1,377.90
|
| Rate for Payer: First Health Workers Compensation |
$591.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,377.90
|
| Rate for Payer: GEHA Commercial |
$1,071.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,377.90
|
| Rate for Payer: Multiplan All |
$1,393.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,071.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,377.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,454.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,148.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,423.83
|
| Rate for Payer: Zelis Auto |
$612.40
|
| Rate for Payer: Zelis Worker's Compensation |
$417.96
|
|
|
EXTENSIVE TESTIS SURGERY
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
CPT 54535
|
| Hospital Charge Code |
6154535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.96 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$918.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$918.60
|
| Rate for Payer: Cash Price |
$918.60
|
| Rate for Payer: Cigna Commercial |
$1,301.35
|
| Rate for Payer: First Health Commercial |
$1,377.90
|
| Rate for Payer: First Health Workers Compensation |
$591.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,377.90
|
| Rate for Payer: GEHA Commercial |
$1,224.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,377.90
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,393.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,071.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,377.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,454.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,148.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,423.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$612.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$417.96
|
|
|
EXTENSIVE THYROID SURGERY
|
Facility
|
IP
|
$3,497.00
|
|
|
Service Code
|
CPT 60254
|
| Hospital Charge Code |
6160254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$954.68 |
| Max. Negotiated Rate |
$3,322.15 |
| Rate for Payer: Cash Price |
$2,098.20
|
| Rate for Payer: Cigna Commercial |
$2,972.45
|
| Rate for Payer: First Health Commercial |
$3,147.30
|
| Rate for Payer: First Health Workers Compensation |
$1,350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,147.30
|
| Rate for Payer: GEHA Commercial |
$2,447.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,147.30
|
| Rate for Payer: Multiplan All |
$3,182.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,447.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,147.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,322.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,622.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,252.21
|
| Rate for Payer: Zelis Auto |
$1,398.80
|
| Rate for Payer: Zelis Worker's Compensation |
$954.68
|
|
|
EXTENSIVE THYROID SURGERY
|
Facility
|
OP
|
$3,497.00
|
|
|
Service Code
|
CPT 60254
|
| Hospital Charge Code |
6160254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$874.25 |
| Max. Negotiated Rate |
$3,322.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,098.20
|
| Rate for Payer: Cash Price |
$2,098.20
|
| Rate for Payer: Cigna Commercial |
$2,972.45
|
| Rate for Payer: First Health Commercial |
$3,147.30
|
| Rate for Payer: First Health Workers Compensation |
$1,350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,147.30
|
| Rate for Payer: GEHA Commercial |
$2,797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,147.30
|
| Rate for Payer: Humana ChoiceCare |
$909.22
|
| Rate for Payer: Multiplan All |
$3,182.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,098.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,447.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,147.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,322.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,622.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,077.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$874.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,252.21
|
| Rate for Payer: Zelis Auto |
$1,398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,748.50
|
| Rate for Payer: Zelis Worker's Compensation |
$954.68
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
IP
|
$2,456.00
|
|
|
Service Code
|
CPT 56631
|
| Hospital Charge Code |
6156631
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$670.49 |
| Max. Negotiated Rate |
$2,333.20 |
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$2,087.60
|
| Rate for Payer: First Health Commercial |
$2,210.40
|
| Rate for Payer: First Health Workers Compensation |
$948.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,210.40
|
| Rate for Payer: GEHA Commercial |
$1,719.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,210.40
|
| Rate for Payer: Multiplan All |
$2,234.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,719.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,210.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,333.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,842.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,284.08
|
| Rate for Payer: Zelis Auto |
$982.40
|
| Rate for Payer: Zelis Worker's Compensation |
$670.49
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
OP
|
$3,136.00
|
|
|
Service Code
|
CPT 56637
|
| Hospital Charge Code |
6156637
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: First Health Workers Compensation |
$1,210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,508.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Humana ChoiceCare |
$815.36
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,881.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,759.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$784.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,568.00
|
| Rate for Payer: Zelis Worker's Compensation |
$856.13
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
OP
|
$2,456.00
|
|
|
Service Code
|
CPT 56631
|
| Hospital Charge Code |
6156631
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$2,333.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,473.60
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$2,087.60
|
| Rate for Payer: First Health Commercial |
$2,210.40
|
| Rate for Payer: First Health Workers Compensation |
$948.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,210.40
|
| Rate for Payer: GEHA Commercial |
$1,964.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,210.40
|
| Rate for Payer: Humana ChoiceCare |
$638.56
|
| Rate for Payer: Multiplan All |
$2,234.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,473.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,719.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,210.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,333.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,842.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,161.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,284.08
|
| Rate for Payer: Zelis Auto |
$982.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,228.00
|
| Rate for Payer: Zelis Worker's Compensation |
$670.49
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
IP
|
$1,919.00
|
|
|
Service Code
|
CPT 56630
|
| Hospital Charge Code |
6156630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$523.89 |
| Max. Negotiated Rate |
$1,823.05 |
| Rate for Payer: Cash Price |
$1,151.40
|
| Rate for Payer: Cigna Commercial |
$1,631.15
|
| Rate for Payer: First Health Commercial |
$1,727.10
|
| Rate for Payer: First Health Workers Compensation |
$740.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,727.10
|
| Rate for Payer: GEHA Commercial |
$1,343.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,727.10
|
| Rate for Payer: Multiplan All |
$1,746.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,343.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,727.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,823.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,439.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,784.67
|
| Rate for Payer: Zelis Auto |
$767.60
|
| Rate for Payer: Zelis Worker's Compensation |
$523.89
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
IP
|
$3,136.00
|
|
|
Service Code
|
CPT 56637
|
| Hospital Charge Code |
6156637
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$856.13 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: First Health Workers Compensation |
$1,210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
| Rate for Payer: Zelis Worker's Compensation |
$856.13
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
OP
|
$2,726.00
|
|
|
Service Code
|
CPT 56634
|
| Hospital Charge Code |
6156634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.50 |
| Max. Negotiated Rate |
$2,589.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,635.60
|
| Rate for Payer: Cash Price |
$1,635.60
|
| Rate for Payer: Cigna Commercial |
$2,317.10
|
| Rate for Payer: First Health Commercial |
$2,453.40
|
| Rate for Payer: First Health Workers Compensation |
$1,052.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,453.40
|
| Rate for Payer: GEHA Commercial |
$2,180.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,453.40
|
| Rate for Payer: Humana ChoiceCare |
$708.76
|
| Rate for Payer: Multiplan All |
$2,480.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,635.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,908.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,453.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,589.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,044.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,398.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$681.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,535.18
|
| Rate for Payer: Zelis Auto |
$1,090.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,363.00
|
| Rate for Payer: Zelis Worker's Compensation |
$744.20
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
IP
|
$2,726.00
|
|
|
Service Code
|
CPT 56634
|
| Hospital Charge Code |
6156634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$744.20 |
| Max. Negotiated Rate |
$2,589.70 |
| Rate for Payer: Cash Price |
$1,635.60
|
| Rate for Payer: Cigna Commercial |
$2,317.10
|
| Rate for Payer: First Health Commercial |
$2,453.40
|
| Rate for Payer: First Health Workers Compensation |
$1,052.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,453.40
|
| Rate for Payer: GEHA Commercial |
$1,908.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,453.40
|
| Rate for Payer: Multiplan All |
$2,480.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,908.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,453.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,589.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,044.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,535.18
|
| Rate for Payer: Zelis Auto |
$1,090.40
|
| Rate for Payer: Zelis Worker's Compensation |
$744.20
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
OP
|
$2,517.00
|
|
|
Service Code
|
CPT 56633
|
| Hospital Charge Code |
6156633
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$629.25 |
| Max. Negotiated Rate |
$2,391.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,510.20
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Cigna Commercial |
$2,139.45
|
| Rate for Payer: First Health Commercial |
$2,265.30
|
| Rate for Payer: First Health Workers Compensation |
$971.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,265.30
|
| Rate for Payer: GEHA Commercial |
$2,013.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,265.30
|
| Rate for Payer: Humana ChoiceCare |
$654.42
|
| Rate for Payer: Multiplan All |
$2,290.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,510.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,761.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,265.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,391.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,887.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,214.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$629.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,340.81
|
| Rate for Payer: Zelis Auto |
$1,006.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,258.50
|
| Rate for Payer: Zelis Worker's Compensation |
$687.14
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
CPT 56632
|
| Hospital Charge Code |
6156632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.75 |
| Max. Negotiated Rate |
$2,704.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,708.20
|
| Rate for Payer: Cigna Commercial |
$2,419.95
|
| Rate for Payer: First Health Commercial |
$2,562.30
|
| Rate for Payer: First Health Workers Compensation |
$1,099.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,562.30
|
| Rate for Payer: GEHA Commercial |
$2,277.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,562.30
|
| Rate for Payer: Humana ChoiceCare |
$740.22
|
| Rate for Payer: Multiplan All |
$2,590.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,708.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,992.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,562.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,704.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,135.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,505.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$711.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,647.71
|
| Rate for Payer: Zelis Auto |
$1,138.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,423.50
|
| Rate for Payer: Zelis Worker's Compensation |
$777.23
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
OP
|
$3,165.00
|
|
|
Service Code
|
CPT 56640
|
| Hospital Charge Code |
6156640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$791.25 |
| Max. Negotiated Rate |
$3,006.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,899.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna Commercial |
$2,690.25
|
| Rate for Payer: First Health Commercial |
$2,848.50
|
| Rate for Payer: First Health Workers Compensation |
$1,222.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,848.50
|
| Rate for Payer: GEHA Commercial |
$2,532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,848.50
|
| Rate for Payer: Humana ChoiceCare |
$822.90
|
| Rate for Payer: Multiplan All |
$2,880.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,899.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,215.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,848.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,006.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,373.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,785.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,943.45
|
| Rate for Payer: Zelis Auto |
$1,266.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,582.50
|
| Rate for Payer: Zelis Worker's Compensation |
$864.04
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
OP
|
$1,919.00
|
|
|
Service Code
|
CPT 56630
|
| Hospital Charge Code |
6156630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$479.75 |
| Max. Negotiated Rate |
$1,823.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,151.40
|
| Rate for Payer: Cash Price |
$1,151.40
|
| Rate for Payer: Cigna Commercial |
$1,631.15
|
| Rate for Payer: First Health Commercial |
$1,727.10
|
| Rate for Payer: First Health Workers Compensation |
$740.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,727.10
|
| Rate for Payer: GEHA Commercial |
$1,535.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,727.10
|
| Rate for Payer: Humana ChoiceCare |
$498.94
|
| Rate for Payer: Multiplan All |
$1,746.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,151.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,343.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,727.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,823.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,439.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,688.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$479.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,784.67
|
| Rate for Payer: Zelis Auto |
$767.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$959.50
|
| Rate for Payer: Zelis Worker's Compensation |
$523.89
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
IP
|
$3,165.00
|
|
|
Service Code
|
CPT 56640
|
| Hospital Charge Code |
6156640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$864.04 |
| Max. Negotiated Rate |
$3,006.75 |
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna Commercial |
$2,690.25
|
| Rate for Payer: First Health Commercial |
$2,848.50
|
| Rate for Payer: First Health Workers Compensation |
$1,222.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,848.50
|
| Rate for Payer: GEHA Commercial |
$2,215.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,848.50
|
| Rate for Payer: Multiplan All |
$2,880.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,215.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,848.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,006.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,373.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,943.45
|
| Rate for Payer: Zelis Auto |
$1,266.00
|
| Rate for Payer: Zelis Worker's Compensation |
$864.04
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
IP
|
$2,517.00
|
|
|
Service Code
|
CPT 56633
|
| Hospital Charge Code |
6156633
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$687.14 |
| Max. Negotiated Rate |
$2,391.15 |
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Cigna Commercial |
$2,139.45
|
| Rate for Payer: First Health Commercial |
$2,265.30
|
| Rate for Payer: First Health Workers Compensation |
$971.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,265.30
|
| Rate for Payer: GEHA Commercial |
$1,761.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,265.30
|
| Rate for Payer: Multiplan All |
$2,290.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,761.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,265.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,391.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,887.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,340.81
|
| Rate for Payer: Zelis Auto |
$1,006.80
|
| Rate for Payer: Zelis Worker's Compensation |
$687.14
|
|
|
EXTENSIVE VULVA SURGERY
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
CPT 56632
|
| Hospital Charge Code |
6156632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$777.23 |
| Max. Negotiated Rate |
$2,704.65 |
| Rate for Payer: Cash Price |
$1,708.20
|
| Rate for Payer: Cigna Commercial |
$2,419.95
|
| Rate for Payer: First Health Commercial |
$2,562.30
|
| Rate for Payer: First Health Workers Compensation |
$1,099.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,562.30
|
| Rate for Payer: GEHA Commercial |
$1,992.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,562.30
|
| Rate for Payer: Multiplan All |
$2,590.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,992.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,562.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,704.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,135.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,647.71
|
| Rate for Payer: Zelis Auto |
$1,138.80
|
| Rate for Payer: Zelis Worker's Compensation |
$777.23
|
|
|
EXTERNAL </30DAYS RECORD MONITOR
|
Facility
|
OP
|
$657.61
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
4093270
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$624.73 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$394.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$394.57
|
| Rate for Payer: Cash Price |
$394.57
|
| Rate for Payer: Cigna Commercial |
$558.97
|
| Rate for Payer: First Health Commercial |
$591.85
|
| Rate for Payer: First Health Workers Compensation |
$253.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$591.85
|
| Rate for Payer: GEHA Commercial |
$526.09
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$591.85
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$598.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$460.33
|
| Rate for Payer: One Health Plan PPO/POS |
$591.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$624.73
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$493.21
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Commercial |
$558.97
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$263.04
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$179.53
|
|
|
EXTERNAL </30DAYS RECORD MONITOR
|
Facility
|
IP
|
$657.61
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
4093270
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$179.53 |
| Max. Negotiated Rate |
$624.73 |
| Rate for Payer: Cash Price |
$394.57
|
| Rate for Payer: Cigna Commercial |
$558.97
|
| Rate for Payer: First Health Commercial |
$591.85
|
| Rate for Payer: First Health Workers Compensation |
$253.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$591.85
|
| Rate for Payer: GEHA Commercial |
$460.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$591.85
|
| Rate for Payer: Multiplan All |
$598.43
|
| Rate for Payer: OMNI Networks Commercial |
$460.33
|
| Rate for Payer: One Health Plan PPO/POS |
$591.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$624.73
|
| Rate for Payer: Three Rivers Provider Network All |
$493.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.58
|
| Rate for Payer: Zelis Auto |
$263.04
|
| Rate for Payer: Zelis Worker's Compensation |
$179.53
|
|
|
EXTERNAL ECG REC>7D<15D SCAN ALYS REPORT
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT 93245
|
| Hospital Charge Code |
8693245
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$201.47 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$627.30
|
| Rate for Payer: First Health Commercial |
$664.20
|
| Rate for Payer: First Health Workers Compensation |
$284.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$664.20
|
| Rate for Payer: GEHA Commercial |
$516.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$664.20
|
| Rate for Payer: Multiplan All |
$671.58
|
| Rate for Payer: OMNI Networks Commercial |
$516.60
|
| Rate for Payer: One Health Plan PPO/POS |
$664.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$701.10
|
| Rate for Payer: Three Rivers Provider Network All |
$553.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$686.34
|
| Rate for Payer: Zelis Auto |
$295.20
|
| Rate for Payer: Zelis Worker's Compensation |
$201.47
|
|
|
EXTERNAL ECG REC>7D<15D SCAN ALYS REPORT
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
CPT 93245
|
| Hospital Charge Code |
8693245
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$627.30
|
| Rate for Payer: First Health Commercial |
$664.20
|
| Rate for Payer: First Health Workers Compensation |
$284.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$664.20
|
| Rate for Payer: GEHA Commercial |
$590.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$664.20
|
| Rate for Payer: Humana ChoiceCare |
$191.88
|
| Rate for Payer: Multiplan All |
$671.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$442.80
|
| Rate for Payer: OMNI Networks Commercial |
$516.60
|
| Rate for Payer: One Health Plan PPO/POS |
$664.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$701.10
|
| Rate for Payer: Three Rivers Provider Network All |
$553.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$649.44
|
| Rate for Payer: United Healthcare Commercial |
$627.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$184.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$686.34
|
| Rate for Payer: Zelis Auto |
$295.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$369.00
|
| Rate for Payer: Zelis Worker's Compensation |
$201.47
|
|
