|
IR ARTHROGRAM SHOULDER RT
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2400037
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,483.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$937.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cigna Commercial |
$1,327.70
|
| Rate for Payer: First Health Commercial |
$1,405.80
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,405.80
|
| Rate for Payer: GEHA Commercial |
$1,249.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,405.80
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,421.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,093.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,405.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,483.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,171.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,327.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,452.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$624.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
IR ARTHROGRAM SHOULDER RT
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2400037
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,483.90 |
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cigna Commercial |
$1,327.70
|
| Rate for Payer: First Health Commercial |
$1,405.80
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,405.80
|
| Rate for Payer: GEHA Commercial |
$1,093.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,405.80
|
| Rate for Payer: Multiplan All |
$1,421.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,093.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,405.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,483.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,171.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,452.66
|
| Rate for Payer: Zelis Auto |
$624.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
IR ARTHROGRAM SI JOINT
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
7727096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$426.97 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: First Health Commercial |
$1,407.60
|
| Rate for Payer: First Health Workers Compensation |
$603.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,407.60
|
| Rate for Payer: GEHA Commercial |
$1,094.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,407.60
|
| Rate for Payer: Multiplan All |
$1,423.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,407.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,485.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,454.52
|
| Rate for Payer: Zelis Auto |
$625.60
|
| Rate for Payer: Zelis Worker's Compensation |
$426.97
|
|
|
IR ARTHROGRAM SI JOINT
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
7727096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.31 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$938.40
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: First Health Commercial |
$1,407.60
|
| Rate for Payer: First Health Workers Compensation |
$478.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,407.60
|
| Rate for Payer: GEHA Commercial |
$1,251.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$406.64
|
| Rate for Payer: Multiplan All |
$1,423.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$938.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,407.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,485.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,376.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,454.52
|
| Rate for Payer: Zelis Auto |
$625.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$782.00
|
| Rate for Payer: Zelis Worker's Compensation |
$338.31
|
|
|
IR ARTHROGRAM TMJ incl upper/lower bones
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
7721116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$604.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Humana ChoiceCare |
$37.70
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.00
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$127.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$72.50
|
| Rate for Payer: Zelis Worker's Compensation |
$427.07
|
|
|
IR ARTHROGRAM TMJ incl upper/lower bones
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
7721116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$55.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$101.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.59
|
|
|
IR ARTHROGRAM WRIST
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
7725246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$738.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$563.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| Rate for Payer: Humana ChoiceCare |
$202.02
|
| Rate for Payer: Multiplan All |
$707.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$466.20
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$738.15
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$683.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$722.61
|
| Rate for Payer: Zelis Auto |
$310.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$388.50
|
| Rate for Payer: Zelis Worker's Compensation |
$398.70
|
|
|
IR ARTHROGRAM WRIST
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
7725246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.12 |
| Max. Negotiated Rate |
$738.15 |
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$300.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$543.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| Rate for Payer: Multiplan All |
$707.07
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$738.15
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$722.61
|
| Rate for Payer: Zelis Auto |
$310.80
|
| Rate for Payer: Zelis Worker's Compensation |
$212.12
|
|
|
IR ARTHROGRAM WRIST
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
2473115
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$116.06 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: First Health Commercial |
$1,350.00
|
| Rate for Payer: First Health Workers Compensation |
$164.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.00
|
| Rate for Payer: GEHA Commercial |
$1,200.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.00
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,365.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,275.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$600.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$116.06
|
|
|
IR ARTHROGRAM WRIST
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
2473115
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$116.06 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: First Health Commercial |
$1,350.00
|
| Rate for Payer: First Health Workers Compensation |
$164.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.00
|
| Rate for Payer: GEHA Commercial |
$1,050.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.00
|
| Rate for Payer: Multiplan All |
$1,365.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.00
|
| Rate for Payer: Zelis Auto |
$600.00
|
| Rate for Payer: Zelis Worker's Compensation |
$116.06
|
|
|
IR ASPIRAT ABSCESS HEMATOMA CYST/BULLA
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7710160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.44 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$364.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$660.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| Rate for Payer: Multiplan All |
$858.13
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$895.85
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.99
|
| Rate for Payer: Zelis Auto |
$377.20
|
| Rate for Payer: Zelis Worker's Compensation |
$257.44
|
|
|
IR ASPIRAT ABSCESS HEMATOMA CYST/BULLA
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7710160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$565.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$488.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$754.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$858.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$895.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$377.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$345.23
|
|
|
IR BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
7720220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$3,190.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,014.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cigna Commercial |
$2,854.30
|
| Rate for Payer: First Health Commercial |
$3,022.20
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,022.20
|
| Rate for Payer: GEHA Commercial |
$2,686.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,022.20
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$3,055.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,350.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,022.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,190.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,518.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,122.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,343.20
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
7720220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$916.73 |
| Max. Negotiated Rate |
$3,190.10 |
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cigna Commercial |
$2,854.30
|
| Rate for Payer: First Health Commercial |
$3,022.20
|
| Rate for Payer: First Health Workers Compensation |
$1,296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,022.20
|
| Rate for Payer: GEHA Commercial |
$2,350.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,022.20
|
| Rate for Payer: Multiplan All |
$3,055.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,350.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,022.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,190.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,518.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,122.94
|
| Rate for Payer: Zelis Auto |
$1,343.20
|
| Rate for Payer: Zelis Worker's Compensation |
$916.73
|
|
|
IR BONE MARROW ASPIRATE W/BIOPSY
|
Facility
|
IP
|
$3,767.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
7700001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,028.39 |
| Max. Negotiated Rate |
$3,578.65 |
| Rate for Payer: Cash Price |
$2,260.20
|
| Rate for Payer: Cigna Commercial |
$3,201.95
|
| Rate for Payer: First Health Commercial |
$3,390.30
|
| Rate for Payer: First Health Workers Compensation |
$1,454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,390.30
|
| Rate for Payer: GEHA Commercial |
$2,636.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,390.30
|
| Rate for Payer: Multiplan All |
$3,427.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,636.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,390.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,578.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,825.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,503.31
|
| Rate for Payer: Zelis Auto |
$1,506.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,028.39
|
|
|
IR BONE MARROW ASPIRATE W/BIOPSY
|
Facility
|
OP
|
$3,767.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
7700001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,506.80 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,021.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,260.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,021.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,601.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$2,260.20
|
| Rate for Payer: Cash Price |
$2,260.20
|
| Rate for Payer: Cigna Commercial |
$3,201.95
|
| Rate for Payer: First Health Commercial |
$3,390.30
|
| Rate for Payer: First Health Workers Compensation |
$3,497.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,390.30
|
| Rate for Payer: GEHA Commercial |
$3,013.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,390.30
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,634.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$3,427.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,636.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,390.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,887.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,634.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,578.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,825.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,634.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,503.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$1,506.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$2,473.04
|
|
|
IR BONE MARROW ASPIRATION ONLY
|
Facility
|
IP
|
$3,877.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
7738220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,058.42 |
| Max. Negotiated Rate |
$3,683.15 |
| Rate for Payer: Cash Price |
$2,326.20
|
| Rate for Payer: Cigna Commercial |
$3,295.45
|
| Rate for Payer: First Health Commercial |
$3,489.30
|
| Rate for Payer: First Health Workers Compensation |
$1,496.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,489.30
|
| Rate for Payer: GEHA Commercial |
$2,713.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,489.30
|
| Rate for Payer: Multiplan All |
$3,528.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,713.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,489.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,683.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,907.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,605.61
|
| Rate for Payer: Zelis Auto |
$1,550.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,058.42
|
|
|
IR BONE MARROW ASPIRATION ONLY
|
Facility
|
OP
|
$3,877.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
7738220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$3,683.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$313.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,326.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$313.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$248.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,326.20
|
| Rate for Payer: Cash Price |
$2,326.20
|
| Rate for Payer: Cigna Commercial |
$3,295.45
|
| Rate for Payer: First Health Commercial |
$3,489.30
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,489.30
|
| Rate for Payer: GEHA Commercial |
$3,101.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,489.30
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$253.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$3,528.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,713.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,489.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$292.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$253.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,683.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,907.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,605.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,550.80
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BONE MARROW BX NEEDLE/TROCAR
|
Facility
|
IP
|
$3,268.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
7738221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$892.16 |
| Max. Negotiated Rate |
$3,104.60 |
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cigna Commercial |
$2,777.80
|
| Rate for Payer: First Health Commercial |
$2,941.20
|
| Rate for Payer: First Health Workers Compensation |
$1,261.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,941.20
|
| Rate for Payer: GEHA Commercial |
$2,287.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,941.20
|
| Rate for Payer: Multiplan All |
$2,973.88
|
| Rate for Payer: OMNI Networks Commercial |
$2,287.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,941.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,104.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,451.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,039.24
|
| Rate for Payer: Zelis Auto |
$1,307.20
|
| Rate for Payer: Zelis Worker's Compensation |
$892.16
|
|
|
IR BONE MARROW BX NEEDLE/TROCAR
|
Facility
|
OP
|
$3,268.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
7738221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$3,104.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$313.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,960.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$313.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$248.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cigna Commercial |
$2,777.80
|
| Rate for Payer: First Health Commercial |
$2,941.20
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,941.20
|
| Rate for Payer: GEHA Commercial |
$2,614.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,941.20
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$253.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$2,973.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,287.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,941.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$292.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$253.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,104.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,451.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,039.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,307.20
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BREAST 1ST LESION US IMAG
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
6119083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$531.26 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,167.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$773.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cigna Commercial |
$1,654.10
|
| Rate for Payer: First Health Commercial |
$1,751.40
|
| Rate for Payer: First Health Workers Compensation |
$751.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,751.40
|
| Rate for Payer: GEHA Commercial |
$1,556.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,751.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$789.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,770.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,362.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,751.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$911.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$789.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,848.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,459.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,809.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$778.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$531.26
|
|
|
IR BREAST 1ST LESION US IMAG
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
6119083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$531.26 |
| Max. Negotiated Rate |
$1,848.70 |
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cigna Commercial |
$1,654.10
|
| Rate for Payer: First Health Commercial |
$1,751.40
|
| Rate for Payer: First Health Workers Compensation |
$751.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,751.40
|
| Rate for Payer: GEHA Commercial |
$1,362.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,751.40
|
| Rate for Payer: Multiplan All |
$1,770.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,362.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,751.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,848.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,459.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,809.78
|
| Rate for Payer: Zelis Auto |
$778.40
|
| Rate for Payer: Zelis Worker's Compensation |
$531.26
|
|
|
IR BREAST CYST ASPIRATION
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
2419000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.05 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Cigna Commercial |
$1,286.05
|
| Rate for Payer: First Health Commercial |
$1,361.70
|
| Rate for Payer: First Health Workers Compensation |
$584.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,361.70
|
| Rate for Payer: GEHA Commercial |
$1,059.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,361.70
|
| Rate for Payer: Multiplan All |
$1,376.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,059.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,361.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,437.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,407.09
|
| Rate for Payer: Zelis Auto |
$605.20
|
| Rate for Payer: Zelis Worker's Compensation |
$413.05
|
|
|
IR BREAST CYST ASPIRATION
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
2419000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.38 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$907.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Cigna Commercial |
$1,286.05
|
| Rate for Payer: First Health Commercial |
$1,361.70
|
| Rate for Payer: First Health Workers Compensation |
$584.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,361.70
|
| Rate for Payer: GEHA Commercial |
$1,210.40
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,361.70
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$1,376.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,059.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,361.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,437.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Commercial |
$1,286.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,407.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$605.20
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$413.05
|
|
|
IR BX ABD/RETROPERITNL
|
Facility
|
IP
|
$1,406.00
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
2467174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$383.84 |
| Max. Negotiated Rate |
$1,335.70 |
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$1,195.10
|
| Rate for Payer: First Health Commercial |
$1,265.40
|
| Rate for Payer: First Health Workers Compensation |
$542.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,265.40
|
| Rate for Payer: GEHA Commercial |
$984.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,265.40
|
| Rate for Payer: Multiplan All |
$1,279.46
|
| Rate for Payer: OMNI Networks Commercial |
$984.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,265.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,335.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,054.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,307.58
|
| Rate for Payer: Zelis Auto |
$562.40
|
| Rate for Payer: Zelis Worker's Compensation |
$383.84
|
|
