|
LEFORT III W/FHD W/ LEFORT I
|
Facility
|
OP
|
$6,556.00
|
|
|
Service Code
|
CPT 21160
|
| Hospital Charge Code |
6121160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,639.00 |
| Max. Negotiated Rate |
$6,228.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,933.60
|
| Rate for Payer: Cash Price |
$3,933.60
|
| Rate for Payer: Cigna Commercial |
$5,572.60
|
| Rate for Payer: First Health Commercial |
$5,900.40
|
| Rate for Payer: First Health Workers Compensation |
$2,531.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,900.40
|
| Rate for Payer: GEHA Commercial |
$5,244.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,900.40
|
| Rate for Payer: Humana ChoiceCare |
$1,704.56
|
| Rate for Payer: Multiplan All |
$5,965.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,933.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,589.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,900.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,228.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,917.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,769.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,097.08
|
| Rate for Payer: Zelis Auto |
$2,622.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,278.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,789.79
|
|
|
LEFORT III W/FHD W/ LEFORT I
|
Facility
|
IP
|
$6,556.00
|
|
|
Service Code
|
CPT 21160
|
| Hospital Charge Code |
6121160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,789.79 |
| Max. Negotiated Rate |
$6,228.20 |
| Rate for Payer: Cash Price |
$3,933.60
|
| Rate for Payer: Cigna Commercial |
$5,572.60
|
| Rate for Payer: First Health Commercial |
$5,900.40
|
| Rate for Payer: First Health Workers Compensation |
$2,531.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,900.40
|
| Rate for Payer: GEHA Commercial |
$4,589.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,900.40
|
| Rate for Payer: Multiplan All |
$5,965.96
|
| Rate for Payer: OMNI Networks Commercial |
$4,589.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,900.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,228.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,917.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,097.08
|
| Rate for Payer: Zelis Auto |
$2,622.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,789.79
|
|
|
LEFORT III W/FHDW/O LEFORT I
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
CPT 21159
|
| Hospital Charge Code |
6121159
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,417.42 |
| Max. Negotiated Rate |
$4,932.40 |
| Rate for Payer: Cash Price |
$3,115.20
|
| Rate for Payer: Cigna Commercial |
$4,413.20
|
| Rate for Payer: First Health Commercial |
$4,672.80
|
| Rate for Payer: First Health Workers Compensation |
$2,004.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,672.80
|
| Rate for Payer: GEHA Commercial |
$3,634.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,672.80
|
| Rate for Payer: Multiplan All |
$4,724.72
|
| Rate for Payer: OMNI Networks Commercial |
$3,634.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,672.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,932.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,894.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,828.56
|
| Rate for Payer: Zelis Auto |
$2,076.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,417.42
|
|
|
LEFORT III W/FHDW/O LEFORT I
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
CPT 21159
|
| Hospital Charge Code |
6121159
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,298.00 |
| Max. Negotiated Rate |
$4,932.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,115.20
|
| Rate for Payer: Cash Price |
$3,115.20
|
| Rate for Payer: Cigna Commercial |
$4,413.20
|
| Rate for Payer: First Health Commercial |
$4,672.80
|
| Rate for Payer: First Health Workers Compensation |
$2,004.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,672.80
|
| Rate for Payer: GEHA Commercial |
$4,153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,672.80
|
| Rate for Payer: Humana ChoiceCare |
$1,349.92
|
| Rate for Payer: Multiplan All |
$4,724.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,115.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,634.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,672.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,932.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,894.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,568.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,298.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,828.56
|
| Rate for Payer: Zelis Auto |
$2,076.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,596.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,417.42
|
|
|
LEFORT III W/ LEFORT I
|
Facility
|
IP
|
$4,453.00
|
|
|
Service Code
|
CPT 21155
|
| Hospital Charge Code |
6121155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,215.67 |
| Max. Negotiated Rate |
$4,230.35 |
| Rate for Payer: Cash Price |
$2,671.80
|
| Rate for Payer: Cigna Commercial |
$3,785.05
|
| Rate for Payer: First Health Commercial |
$4,007.70
|
| Rate for Payer: First Health Workers Compensation |
$1,719.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,007.70
|
| Rate for Payer: GEHA Commercial |
$3,117.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,007.70
|
| Rate for Payer: Multiplan All |
$4,052.23
|
| Rate for Payer: OMNI Networks Commercial |
$3,117.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,007.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,230.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,339.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,141.29
|
| Rate for Payer: Zelis Auto |
$1,781.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,215.67
|
|
|
LEFORT III W/ LEFORT I
|
Facility
|
OP
|
$4,453.00
|
|
|
Service Code
|
CPT 21155
|
| Hospital Charge Code |
6121155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,113.25 |
| Max. Negotiated Rate |
$4,230.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,671.80
|
| Rate for Payer: Cash Price |
$2,671.80
|
| Rate for Payer: Cigna Commercial |
$3,785.05
|
| Rate for Payer: First Health Commercial |
$4,007.70
|
| Rate for Payer: First Health Workers Compensation |
$1,719.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,007.70
|
| Rate for Payer: GEHA Commercial |
$3,562.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,007.70
|
| Rate for Payer: Humana ChoiceCare |
$1,157.78
|
| Rate for Payer: Multiplan All |
$4,052.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,671.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,117.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,007.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,230.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,339.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,918.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,141.29
|
| Rate for Payer: Zelis Auto |
$1,781.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,226.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,215.67
|
|
|
LEFORT III W/O LEFORT I
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
CPT 21154
|
| Hospital Charge Code |
6121154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,179.36 |
| Max. Negotiated Rate |
$4,104.00 |
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna Commercial |
$3,672.00
|
| Rate for Payer: First Health Commercial |
$3,888.00
|
| Rate for Payer: First Health Workers Compensation |
$1,667.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,888.00
|
| Rate for Payer: GEHA Commercial |
$3,024.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,888.00
|
| Rate for Payer: Multiplan All |
$3,931.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,024.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,888.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,104.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,240.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,017.60
|
| Rate for Payer: Zelis Auto |
$1,728.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,179.36
|
|
|
LEFORT III W/O LEFORT I
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
CPT 21154
|
| Hospital Charge Code |
6121154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$4,104.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna Commercial |
$3,672.00
|
| Rate for Payer: First Health Commercial |
$3,888.00
|
| Rate for Payer: First Health Workers Compensation |
$1,667.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,888.00
|
| Rate for Payer: GEHA Commercial |
$3,456.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,888.00
|
| Rate for Payer: Humana ChoiceCare |
$1,123.20
|
| Rate for Payer: Multiplan All |
$3,931.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,592.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,024.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,888.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,104.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,240.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,801.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,080.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,017.60
|
| Rate for Payer: Zelis Auto |
$1,728.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,179.36
|
|
|
LEFORT II W/BONE GRAFTS
|
Facility
|
IP
|
$4,154.00
|
|
|
Service Code
|
CPT 21151
|
| Hospital Charge Code |
6121151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,134.04 |
| Max. Negotiated Rate |
$3,946.30 |
| Rate for Payer: Cash Price |
$2,492.40
|
| Rate for Payer: Cigna Commercial |
$3,530.90
|
| Rate for Payer: First Health Commercial |
$3,738.60
|
| Rate for Payer: First Health Workers Compensation |
$1,603.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,738.60
|
| Rate for Payer: GEHA Commercial |
$2,907.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,738.60
|
| Rate for Payer: Multiplan All |
$3,780.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,907.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,738.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,946.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,863.22
|
| Rate for Payer: Zelis Auto |
$1,661.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,134.04
|
|
|
LEFORT II W/BONE GRAFTS
|
Facility
|
OP
|
$4,154.00
|
|
|
Service Code
|
CPT 21151
|
| Hospital Charge Code |
6121151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,038.50 |
| Max. Negotiated Rate |
$3,946.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,492.40
|
| Rate for Payer: Cash Price |
$2,492.40
|
| Rate for Payer: Cigna Commercial |
$3,530.90
|
| Rate for Payer: First Health Commercial |
$3,738.60
|
| Rate for Payer: First Health Workers Compensation |
$1,603.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,738.60
|
| Rate for Payer: GEHA Commercial |
$3,323.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,738.60
|
| Rate for Payer: Humana ChoiceCare |
$1,080.04
|
| Rate for Payer: Multiplan All |
$3,780.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,492.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,907.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,738.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,946.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,655.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,038.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,863.22
|
| Rate for Payer: Zelis Auto |
$1,661.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,077.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,134.04
|
|
|
LEGIONELLA AG EIA URINE REF
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
2300050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$272.80
|
| Rate for Payer: GEHA Medicare |
$11.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Humana ChoiceCare |
$13.18
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.98
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.37
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.96
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$289.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.98
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Medicare |
$10.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.38
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
LEGIONELLA AG EIA URINE REF
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
2300050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$238.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
legionella pneumophila ab REF164616
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2200464
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$23.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$15.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$16.83
|
| Rate for Payer: Humana Medicare Advantage |
$15.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.30
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.01
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.60
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.30
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$13.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.36
|
| Rate for Payer: Zelis Worker's Compensation |
$16.60
|
|
|
legionella pneumophila ab REF164616
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2200464
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$23.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.60
|
|
|
legionella pneumophil urine ag REF182246
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
2200091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$238.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
legionella pneumophil urine ag REF182246
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
2200091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$272.80
|
| Rate for Payer: GEHA Medicare |
$11.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Humana ChoiceCare |
$13.18
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.98
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.37
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.96
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$289.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.98
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Medicare |
$10.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.38
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
LENGTHENING OF HAND TENDON
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 26478
|
| Hospital Charge Code |
6126478
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.06 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$732.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$1,037.00
|
| Rate for Payer: First Health Commercial |
$1,098.00
|
| Rate for Payer: First Health Workers Compensation |
$471.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.00
|
| Rate for Payer: GEHA Commercial |
$976.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.00
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,110.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$854.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$915.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,134.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$488.00
|
| 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 |
$333.06
|
|
|
LENGTHENING OF HAND TENDON
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 26478
|
| Hospital Charge Code |
6126478
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.06 |
| Max. Negotiated Rate |
$1,159.00 |
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$1,037.00
|
| Rate for Payer: First Health Commercial |
$1,098.00
|
| Rate for Payer: First Health Workers Compensation |
$471.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.00
|
| Rate for Payer: GEHA Commercial |
$854.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.00
|
| Rate for Payer: Multiplan All |
$1,110.20
|
| Rate for Payer: OMNI Networks Commercial |
$854.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.00
|
| Rate for Payer: Three Rivers Provider Network All |
$915.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,134.60
|
| Rate for Payer: Zelis Auto |
$488.00
|
| Rate for Payer: Zelis Worker's Compensation |
$333.06
|
|
|
LENGTHENING OF THIGH BONE
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
CPT 27466
|
| Hospital Charge Code |
6127466
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$663.12 |
| Max. Negotiated Rate |
$2,307.55 |
| Rate for Payer: Cash Price |
$1,457.40
|
| Rate for Payer: Cigna Commercial |
$2,064.65
|
| Rate for Payer: First Health Commercial |
$2,186.10
|
| Rate for Payer: First Health Workers Compensation |
$937.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,186.10
|
| Rate for Payer: GEHA Commercial |
$1,700.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,186.10
|
| Rate for Payer: Multiplan All |
$2,210.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,700.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,186.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,307.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,821.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,258.97
|
| Rate for Payer: Zelis Auto |
$971.60
|
| Rate for Payer: Zelis Worker's Compensation |
$663.12
|
|
|
LENGTHENING OF THIGH BONE
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
CPT 27466
|
| Hospital Charge Code |
6127466
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$607.25 |
| Max. Negotiated Rate |
$2,307.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,457.40
|
| Rate for Payer: Cash Price |
$1,457.40
|
| Rate for Payer: Cigna Commercial |
$2,064.65
|
| Rate for Payer: First Health Commercial |
$2,186.10
|
| Rate for Payer: First Health Workers Compensation |
$937.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,186.10
|
| Rate for Payer: GEHA Commercial |
$1,943.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,186.10
|
| Rate for Payer: Humana ChoiceCare |
$631.54
|
| Rate for Payer: Multiplan All |
$2,210.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,457.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,700.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,186.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,307.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,821.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,137.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$607.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,258.97
|
| Rate for Payer: Zelis Auto |
$971.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,214.50
|
| Rate for Payer: Zelis Worker's Compensation |
$663.12
|
|
|
LENGTHENING OF THIGH TENDON
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 27393
|
| Hospital Charge Code |
6127393
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$825.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$281.74
|
|
|
LENGTHENING OF THIGH TENDON
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 27393
|
| Hospital Charge Code |
6127393
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Worker's Compensation |
$281.74
|
|
|
LENGTHENING OF THIGH TENDONS
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
CPT 27395
|
| Hospital Charge Code |
6127395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$492.76 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,083.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,534.25
|
| Rate for Payer: First Health Commercial |
$1,624.50
|
| Rate for Payer: First Health Workers Compensation |
$696.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,624.50
|
| Rate for Payer: GEHA Commercial |
$1,444.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,624.50
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,642.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,263.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,624.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,714.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,353.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,678.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$722.00
|
| 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 |
$492.76
|
|
|
LENGTHENING OF THIGH TENDONS
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT 27394
|
| Hospital Charge Code |
6127394
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.54 |
| Max. Negotiated Rate |
$1,230.25 |
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,100.75
|
| Rate for Payer: First Health Commercial |
$1,165.50
|
| Rate for Payer: First Health Workers Compensation |
$500.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,165.50
|
| Rate for Payer: GEHA Commercial |
$906.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,165.50
|
| Rate for Payer: Multiplan All |
$1,178.45
|
| Rate for Payer: OMNI Networks Commercial |
$906.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,165.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,230.25
|
| Rate for Payer: Three Rivers Provider Network All |
$971.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,204.35
|
| Rate for Payer: Zelis Auto |
$518.00
|
| Rate for Payer: Zelis Worker's Compensation |
$353.54
|
|
|
LENGTHENING OF THIGH TENDONS
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
CPT 27395
|
| Hospital Charge Code |
6127395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$492.76 |
| Max. Negotiated Rate |
$1,714.75 |
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,534.25
|
| Rate for Payer: First Health Commercial |
$1,624.50
|
| Rate for Payer: First Health Workers Compensation |
$696.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,624.50
|
| Rate for Payer: GEHA Commercial |
$1,263.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,624.50
|
| Rate for Payer: Multiplan All |
$1,642.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,263.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,624.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,714.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,353.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,678.65
|
| Rate for Payer: Zelis Auto |
$722.00
|
| Rate for Payer: Zelis Worker's Compensation |
$492.76
|
|
