|
OPTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT 27766
|
| Hospital Charge Code |
6127766
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.16 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$747.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$498.40
|
| 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 |
$340.16
|
|
|
OPTX POST ANKLE FX
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 27769
|
| Hospital Charge Code |
6127769
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$898.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,198.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$599.20
|
| 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 |
$408.95
|
|
|
OPTX POST ANKLE FX
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 27769
|
| Hospital Charge Code |
6127769
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$1,423.10 |
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,048.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: Zelis Auto |
$599.20
|
| Rate for Payer: Zelis Worker's Compensation |
$408.95
|
|
|
OPTX THIGH FX
|
Facility
|
IP
|
$2,568.00
|
|
|
Service Code
|
CPT 27269
|
| Hospital Charge Code |
6127269
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$701.06 |
| Max. Negotiated Rate |
$2,439.60 |
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Cigna Commercial |
$2,182.80
|
| Rate for Payer: First Health Commercial |
$2,311.20
|
| Rate for Payer: First Health Workers Compensation |
$991.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,311.20
|
| Rate for Payer: GEHA Commercial |
$1,797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,311.20
|
| Rate for Payer: Multiplan All |
$2,336.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,797.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,311.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,439.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,926.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,388.24
|
| Rate for Payer: Zelis Auto |
$1,027.20
|
| Rate for Payer: Zelis Worker's Compensation |
$701.06
|
|
|
OPTX THIGH FX
|
Facility
|
OP
|
$2,568.00
|
|
|
Service Code
|
CPT 27269
|
| Hospital Charge Code |
6127269
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$642.00 |
| Max. Negotiated Rate |
$2,439.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,540.80
|
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Cigna Commercial |
$2,182.80
|
| Rate for Payer: First Health Commercial |
$2,311.20
|
| Rate for Payer: First Health Workers Compensation |
$991.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,311.20
|
| Rate for Payer: GEHA Commercial |
$2,054.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,311.20
|
| Rate for Payer: Humana ChoiceCare |
$667.68
|
| Rate for Payer: Multiplan All |
$2,336.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,540.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,797.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,311.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,439.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,926.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,259.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$642.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,388.24
|
| Rate for Payer: Zelis Auto |
$1,027.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,284.00
|
| Rate for Payer: Zelis Worker's Compensation |
$701.06
|
|
|
OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO
|
Facility
|
IP
|
$1,830.00
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
6127758
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$499.59 |
| Max. Negotiated Rate |
$1,738.50 |
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$1,555.50
|
| Rate for Payer: First Health Commercial |
$1,647.00
|
| Rate for Payer: First Health Workers Compensation |
$706.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,647.00
|
| Rate for Payer: GEHA Commercial |
$1,281.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,647.00
|
| Rate for Payer: Multiplan All |
$1,665.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,281.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,647.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,738.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,372.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,701.90
|
| Rate for Payer: Zelis Auto |
$732.00
|
| Rate for Payer: Zelis Worker's Compensation |
$499.59
|
|
|
OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO
|
Facility
|
OP
|
$1,830.00
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
6127758
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$499.59 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,098.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$1,555.50
|
| Rate for Payer: First Health Commercial |
$1,647.00
|
| Rate for Payer: First Health Workers Compensation |
$706.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,647.00
|
| Rate for Payer: GEHA Commercial |
$1,464.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,647.00
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,665.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,281.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,647.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,738.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,372.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,701.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$732.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$499.59
|
|
|
OP - UPGRADE FROM COMPET
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
20500117
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
OP - UPGRADE FROM COMPET
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
21900214
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$52.78
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$121.80
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.64
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.50
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
OP - UPGRADE FROM COMPET
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
20500117
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$52.78
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$121.80
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.64
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.50
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
OP - UPGRADE FROM COMPET
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
21900214
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
ORBERA GASTRIC BALLOON PROCEDURE
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
6100001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.57 |
| Max. Negotiated Rate |
$5,785.50 |
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cigna Commercial |
$5,176.50
|
| Rate for Payer: First Health Commercial |
$5,481.00
|
| Rate for Payer: First Health Workers Compensation |
$2,351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,481.00
|
| Rate for Payer: GEHA Commercial |
$4,263.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,481.00
|
| Rate for Payer: Multiplan All |
$5,541.90
|
| Rate for Payer: OMNI Networks Commercial |
$4,263.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,481.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,785.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,567.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,663.70
|
| Rate for Payer: Zelis Auto |
$2,436.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,662.57
|
|
|
ORBERA GASTRIC BALLOON PROCEDURE
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
6100001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,522.50 |
| Max. Negotiated Rate |
$5,785.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cigna Commercial |
$5,176.50
|
| Rate for Payer: First Health Commercial |
$5,481.00
|
| Rate for Payer: First Health Workers Compensation |
$2,351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,481.00
|
| Rate for Payer: GEHA Commercial |
$4,872.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,481.00
|
| Rate for Payer: Humana ChoiceCare |
$1,583.40
|
| Rate for Payer: Multiplan All |
$5,541.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,654.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,263.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,481.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,785.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,567.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,359.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,522.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,663.70
|
| Rate for Payer: Zelis Auto |
$2,436.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,045.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,662.57
|
|
|
ORCHIECTOMY PARTIAL
|
Facility
|
IP
|
$1,281.00
|
|
|
Service Code
|
CPT 54522
|
| Hospital Charge Code |
6154522
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$349.71 |
| Max. Negotiated Rate |
$1,216.95 |
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,088.85
|
| Rate for Payer: First Health Commercial |
$1,152.90
|
| Rate for Payer: First Health Workers Compensation |
$494.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.90
|
| Rate for Payer: GEHA Commercial |
$896.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.90
|
| Rate for Payer: Multiplan All |
$1,165.71
|
| Rate for Payer: OMNI Networks Commercial |
$896.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.95
|
| Rate for Payer: Three Rivers Provider Network All |
$960.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,191.33
|
| Rate for Payer: Zelis Auto |
$512.40
|
| Rate for Payer: Zelis Worker's Compensation |
$349.71
|
|
|
ORCHIECTOMY PARTIAL
|
Facility
|
OP
|
$1,281.00
|
|
|
Service Code
|
CPT 54522
|
| Hospital Charge Code |
6154522
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$349.71 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$768.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,088.85
|
| Rate for Payer: First Health Commercial |
$1,152.90
|
| Rate for Payer: First Health Workers Compensation |
$494.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.90
|
| Rate for Payer: GEHA Commercial |
$1,024.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.90
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,165.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$896.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$960.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,191.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$512.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$349.71
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$6,701.96
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,560.61 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: First Health Workers Compensation |
$4,312.71
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3,049.39
|
|
|
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH
|
Facility
|
OP
|
$6,549.86
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.00 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: First Health Workers Compensation |
$4,214.83
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$2,980.19
|
|
|
ORCHIOPEXY (FOWLER-STEPHENS)
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 54650
|
| Hospital Charge Code |
6154650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.31 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,326.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,326.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,635.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$1,240.15
|
| Rate for Payer: First Health Commercial |
$1,313.10
|
| Rate for Payer: First Health Workers Compensation |
$563.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,313.10
|
| Rate for Payer: GEHA Commercial |
$1,167.20
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,313.10
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,688.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$1,327.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,021.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,313.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,104.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,688.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,386.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,094.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,688.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,356.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$583.60
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$398.31
|
|
|
ORCHIOPEXY (FOWLER-STEPHENS)
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 54650
|
| Hospital Charge Code |
6154650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.31 |
| Max. Negotiated Rate |
$1,386.05 |
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$1,240.15
|
| Rate for Payer: First Health Commercial |
$1,313.10
|
| Rate for Payer: First Health Workers Compensation |
$563.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,313.10
|
| Rate for Payer: GEHA Commercial |
$1,021.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,313.10
|
| Rate for Payer: Multiplan All |
$1,327.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,021.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,313.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,386.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,094.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,356.87
|
| Rate for Payer: Zelis Auto |
$583.60
|
| Rate for Payer: Zelis Worker's Compensation |
$398.31
|
|
|
organic acid analysis, urine REF716720
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
2299317
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$29.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$16.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$18.09
|
| Rate for Payer: Humana Medicare Advantage |
$16.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.45
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.96
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.90
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.12
|
| Rate for Payer: United Healthcare Commercial |
$243.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.45
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$13.98
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.74
|
| Rate for Payer: Zelis Worker's Compensation |
$20.80
|
|
|
organic acid analysis, urine REF716720
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
2299317
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$29.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$20.80
|
|
|
ORGANISM ID AER
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2200050
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
ORGANISM ID AER
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2200050
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$8.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.08
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.74
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.16
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.08
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$6.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.70
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
organism id, anaerobe REF182345
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
2299058
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$16.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$11.79
|
|
|
organism id, anaerobe REF182345
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
2299058
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$16.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$8.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.08
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.74
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.16
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.08
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$6.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.70
|
| Rate for Payer: Zelis Worker's Compensation |
$11.79
|
|
