|
AMPUTATION OF LOWER LEG
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
CPT 27880
|
| Hospital Charge Code |
6127880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.89 |
| Max. Negotiated Rate |
$1,843.95 |
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cigna Commercial |
$1,649.85
|
| Rate for Payer: First Health Commercial |
$1,746.90
|
| Rate for Payer: First Health Workers Compensation |
$749.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,746.90
|
| Rate for Payer: GEHA Commercial |
$1,358.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,746.90
|
| Rate for Payer: Multiplan All |
$1,766.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,358.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,746.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,843.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,455.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,805.13
|
| Rate for Payer: Zelis Auto |
$776.40
|
| Rate for Payer: Zelis Worker's Compensation |
$529.89
|
|
|
AMPUTATION OF LOWER LEG
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 27882
|
| Hospital Charge Code |
6127882
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.71 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$1,079.50
|
| Rate for Payer: First Health Commercial |
$1,143.00
|
| Rate for Payer: First Health Workers Compensation |
$490.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.00
|
| Rate for Payer: GEHA Commercial |
$889.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.00
|
| Rate for Payer: Multiplan All |
$1,155.70
|
| Rate for Payer: OMNI Networks Commercial |
$889.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,206.50
|
| Rate for Payer: Three Rivers Provider Network All |
$952.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,181.10
|
| Rate for Payer: Zelis Auto |
$508.00
|
| Rate for Payer: Zelis Worker's Compensation |
$346.71
|
|
|
AMPUTATION OF LOWER LEG
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
CPT 27880
|
| Hospital Charge Code |
6127880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.25 |
| Max. Negotiated Rate |
$1,843.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cigna Commercial |
$1,649.85
|
| Rate for Payer: First Health Commercial |
$1,746.90
|
| Rate for Payer: First Health Workers Compensation |
$749.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,746.90
|
| Rate for Payer: GEHA Commercial |
$1,552.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,746.90
|
| Rate for Payer: Humana ChoiceCare |
$504.66
|
| Rate for Payer: Multiplan All |
$1,766.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,164.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,358.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,746.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,843.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,455.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,708.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$485.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,805.13
|
| Rate for Payer: Zelis Auto |
$776.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$970.50
|
| Rate for Payer: Zelis Worker's Compensation |
$529.89
|
|
|
AMPUTATION OF LOWER LEG
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT 27881
|
| Hospital Charge Code |
6127881
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.50 |
| Max. Negotiated Rate |
$1,730.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,093.20
|
| Rate for Payer: Cash Price |
$1,093.20
|
| Rate for Payer: Cigna Commercial |
$1,548.70
|
| Rate for Payer: First Health Commercial |
$1,639.80
|
| Rate for Payer: First Health Workers Compensation |
$703.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,639.80
|
| Rate for Payer: GEHA Commercial |
$1,457.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,639.80
|
| Rate for Payer: Humana ChoiceCare |
$473.72
|
| Rate for Payer: Multiplan All |
$1,658.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,093.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,275.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,639.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,730.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,366.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,603.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$455.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,694.46
|
| Rate for Payer: Zelis Auto |
$728.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$911.00
|
| Rate for Payer: Zelis Worker's Compensation |
$497.41
|
|
|
AMPUTATION OF LOWER LEG
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT 27881
|
| Hospital Charge Code |
6127881
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$497.41 |
| Max. Negotiated Rate |
$1,730.90 |
| Rate for Payer: Cash Price |
$1,093.20
|
| Rate for Payer: Cigna Commercial |
$1,548.70
|
| Rate for Payer: First Health Commercial |
$1,639.80
|
| Rate for Payer: First Health Workers Compensation |
$703.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,639.80
|
| Rate for Payer: GEHA Commercial |
$1,275.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,639.80
|
| Rate for Payer: Multiplan All |
$1,658.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,275.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,639.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,730.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,366.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,694.46
|
| Rate for Payer: Zelis Auto |
$728.80
|
| Rate for Payer: Zelis Worker's Compensation |
$497.41
|
|
|
AMPUTATION OF LOWER LEG
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 27882
|
| Hospital Charge Code |
6127882
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.50 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$762.00
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$1,079.50
|
| Rate for Payer: First Health Commercial |
$1,143.00
|
| Rate for Payer: First Health Workers Compensation |
$490.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.00
|
| Rate for Payer: GEHA Commercial |
$1,016.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.00
|
| Rate for Payer: Humana ChoiceCare |
$330.20
|
| Rate for Payer: Multiplan All |
$1,155.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$762.00
|
| Rate for Payer: OMNI Networks Commercial |
$889.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,206.50
|
| Rate for Payer: Three Rivers Provider Network All |
$952.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,117.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$317.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,181.10
|
| Rate for Payer: Zelis Auto |
$508.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$635.00
|
| Rate for Payer: Zelis Worker's Compensation |
$346.71
|
|
|
AMPUTATION OF MIDFOOT
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
CPT 28800
|
| Hospital Charge Code |
6128800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cigna Commercial |
$952.00
|
| Rate for Payer: First Health Commercial |
$1,008.00
|
| Rate for Payer: First Health Workers Compensation |
$432.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,008.00
|
| Rate for Payer: GEHA Commercial |
$784.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,008.00
|
| Rate for Payer: Multiplan All |
$1,019.20
|
| Rate for Payer: OMNI Networks Commercial |
$784.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,008.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,064.00
|
| Rate for Payer: Three Rivers Provider Network All |
$840.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,041.60
|
| Rate for Payer: Zelis Auto |
$448.00
|
| Rate for Payer: Zelis Worker's Compensation |
$305.76
|
|
|
AMPUTATION OF MIDFOOT
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 28800
|
| Hospital Charge Code |
6128800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cigna Commercial |
$952.00
|
| Rate for Payer: First Health Commercial |
$1,008.00
|
| Rate for Payer: First Health Workers Compensation |
$432.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,008.00
|
| Rate for Payer: GEHA Commercial |
$896.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,008.00
|
| Rate for Payer: Humana ChoiceCare |
$291.20
|
| Rate for Payer: Multiplan All |
$1,019.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$672.00
|
| Rate for Payer: OMNI Networks Commercial |
$784.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,008.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,064.00
|
| Rate for Payer: Three Rivers Provider Network All |
$840.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$985.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,041.60
|
| Rate for Payer: Zelis Auto |
$448.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$560.00
|
| Rate for Payer: Zelis Worker's Compensation |
$305.76
|
|
|
AMPUTATION OF UPPER ARM
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 24920
|
| Hospital Charge Code |
6124920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,424.05 |
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cigna Commercial |
$1,274.15
|
| Rate for Payer: First Health Commercial |
$1,349.10
|
| Rate for Payer: First Health Workers Compensation |
$578.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,349.10
|
| Rate for Payer: GEHA Commercial |
$1,049.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,349.10
|
| Rate for Payer: Multiplan All |
$1,364.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,049.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,349.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,424.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,124.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,394.07
|
| Rate for Payer: Zelis Auto |
$599.60
|
| Rate for Payer: Zelis Worker's Compensation |
$409.23
|
|
|
AMPUTATION OF UPPER ARM
|
Facility
|
IP
|
$1,501.00
|
|
|
Service Code
|
CPT 24900
|
| Hospital Charge Code |
6124900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.77 |
| Max. Negotiated Rate |
$1,425.95 |
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$1,275.85
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: First Health Workers Compensation |
$579.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.90
|
| Rate for Payer: GEHA Commercial |
$1,050.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.90
|
| Rate for Payer: Multiplan All |
$1,365.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.93
|
| Rate for Payer: Zelis Auto |
$600.40
|
| Rate for Payer: Zelis Worker's Compensation |
$409.77
|
|
|
AMPUTATION OF UPPER ARM
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
CPT 24900
|
| Hospital Charge Code |
6124900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.25 |
| Max. Negotiated Rate |
$1,425.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$900.60
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$1,275.85
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: First Health Workers Compensation |
$579.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.90
|
| Rate for Payer: GEHA Commercial |
$1,200.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.90
|
| Rate for Payer: Humana ChoiceCare |
$390.26
|
| Rate for Payer: Multiplan All |
$1,365.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$900.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,320.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.93
|
| Rate for Payer: Zelis Auto |
$600.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$750.50
|
| Rate for Payer: Zelis Worker's Compensation |
$409.77
|
|
|
AMPUTATION OF UPPER ARM
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 24920
|
| Hospital Charge Code |
6124920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.75 |
| Max. Negotiated Rate |
$1,424.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$899.40
|
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cigna Commercial |
$1,274.15
|
| Rate for Payer: First Health Commercial |
$1,349.10
|
| Rate for Payer: First Health Workers Compensation |
$578.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,349.10
|
| Rate for Payer: GEHA Commercial |
$1,199.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,349.10
|
| Rate for Payer: Humana ChoiceCare |
$389.74
|
| Rate for Payer: Multiplan All |
$1,364.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$899.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,049.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,349.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,424.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,124.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,319.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$374.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,394.07
|
| Rate for Payer: Zelis Auto |
$599.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$749.50
|
| Rate for Payer: Zelis Worker's Compensation |
$409.23
|
|
|
AMPUTATION THRU METATARSAL
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 28805
|
| Hospital Charge Code |
6128805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.32 |
| 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 |
$915.00
|
| 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 |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: First Health Workers Compensation |
$588.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,220.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| 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 |
$1,387.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| 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 |
$1,448.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| 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 |
$1,418.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$610.00
|
| 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 |
$416.32
|
|
|
AMPUTATION THRU METATARSAL
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 28805
|
| Hospital Charge Code |
6128805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.32 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: First Health Workers Compensation |
$588.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,067.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
| Rate for Payer: Zelis Worker's Compensation |
$416.32
|
|
|
AMPUTATION TOE & METATARSAL
|
Facility
|
IP
|
$1,209.42
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
6128810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.17 |
| Max. Negotiated Rate |
$1,148.95 |
| Rate for Payer: Cash Price |
$725.65
|
| Rate for Payer: Cigna Commercial |
$1,028.01
|
| Rate for Payer: First Health Commercial |
$1,088.48
|
| Rate for Payer: First Health Workers Compensation |
$466.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.48
|
| Rate for Payer: GEHA Commercial |
$846.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.48
|
| Rate for Payer: Multiplan All |
$1,100.57
|
| Rate for Payer: OMNI Networks Commercial |
$846.59
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.95
|
| Rate for Payer: Three Rivers Provider Network All |
$907.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.76
|
| Rate for Payer: Zelis Auto |
$483.77
|
| Rate for Payer: Zelis Worker's Compensation |
$330.17
|
|
|
AMPUTATION TOE & METATARSAL
|
Facility
|
OP
|
$1,209.42
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
6128810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.17 |
| 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 |
$725.65
|
| 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 |
$725.65
|
| Rate for Payer: Cash Price |
$725.65
|
| Rate for Payer: Cigna Commercial |
$1,028.01
|
| Rate for Payer: First Health Commercial |
$1,088.48
|
| Rate for Payer: First Health Workers Compensation |
$466.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.48
|
| Rate for Payer: GEHA Commercial |
$967.54
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.48
|
| 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 |
$1,100.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$846.59
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.48
|
| 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 |
$1,148.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$907.07
|
| 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 |
$1,124.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$483.77
|
| 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 |
$330.17
|
|
|
AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
6128820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.61 |
| 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 |
$733.20
|
| 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 |
$733.20
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cigna Commercial |
$1,038.70
|
| Rate for Payer: First Health Commercial |
$1,099.80
|
| Rate for Payer: First Health Workers Compensation |
$471.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,099.80
|
| Rate for Payer: GEHA Commercial |
$977.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,099.80
|
| 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 |
$1,112.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$855.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,099.80
|
| 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 |
$1,160.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$916.50
|
| 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 |
$1,136.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$488.80
|
| 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 |
$333.61
|
|
|
AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
6128820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.61 |
| Max. Negotiated Rate |
$1,160.90 |
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cigna Commercial |
$1,038.70
|
| Rate for Payer: First Health Commercial |
$1,099.80
|
| Rate for Payer: First Health Workers Compensation |
$471.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,099.80
|
| Rate for Payer: GEHA Commercial |
$855.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,099.80
|
| Rate for Payer: Multiplan All |
$1,112.02
|
| Rate for Payer: OMNI Networks Commercial |
$855.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,099.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,160.90
|
| Rate for Payer: Three Rivers Provider Network All |
$916.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,136.46
|
| Rate for Payer: Zelis Auto |
$488.80
|
| Rate for Payer: Zelis Worker's Compensation |
$333.61
|
|
|
AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
20300064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$467.38 |
| 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 |
$1,027.20
|
| 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 |
$1,027.20
|
| Rate for Payer: Cash Price |
$1,027.20
|
| Rate for Payer: Cigna Commercial |
$1,455.20
|
| Rate for Payer: First Health Commercial |
$1,540.80
|
| Rate for Payer: First Health Workers Compensation |
$661.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,540.80
|
| Rate for Payer: GEHA Commercial |
$1,369.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,540.80
|
| 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 |
$1,557.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,198.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,540.80
|
| 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 |
$1,626.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,284.00
|
| 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 |
$1,592.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$684.80
|
| 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 |
$467.38
|
|
|
AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
20300064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$467.38 |
| Max. Negotiated Rate |
$1,626.40 |
| Rate for Payer: Cash Price |
$1,027.20
|
| Rate for Payer: Cigna Commercial |
$1,455.20
|
| Rate for Payer: First Health Commercial |
$1,540.80
|
| Rate for Payer: First Health Workers Compensation |
$661.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,540.80
|
| Rate for Payer: GEHA Commercial |
$1,198.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,540.80
|
| Rate for Payer: Multiplan All |
$1,557.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,198.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,540.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,626.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,284.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,592.16
|
| Rate for Payer: Zelis Auto |
$684.80
|
| Rate for Payer: Zelis Worker's Compensation |
$467.38
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| 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 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: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| 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: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 Worker's Compensation |
$6,161.78
|
| 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: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
AMYLASE 24 HR URINE
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
2202152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$6.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$7.13
|
| Rate for Payer: Humana Medicare Advantage |
$6.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.48
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.02
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.43
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.96
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.35
|
| Rate for Payer: United Healthcare Commercial |
$121.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.48
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$5.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.78
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
AMYLASE 24 HR URINE
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
2202152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
AMYLASE Serum (Vitros)
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
2232217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$6.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$7.13
|
| Rate for Payer: Humana Medicare Advantage |
$6.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.48
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.02
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.43
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.96
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.35
|
| Rate for Payer: United Healthcare Commercial |
$121.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.48
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$5.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.78
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
AMYLASE Serum (Vitros)
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
2232217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
