|
ATTACH BLADDER/URETHRA
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 51840
|
| Hospital Charge Code |
6151840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.55 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,147.50
|
| Rate for Payer: First Health Commercial |
$1,215.00
|
| Rate for Payer: First Health Workers Compensation |
$521.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.00
|
| Rate for Payer: GEHA Commercial |
$945.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.00
|
| Rate for Payer: Multiplan All |
$1,228.50
|
| Rate for Payer: OMNI Networks Commercial |
$945.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,282.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,012.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,255.50
|
| Rate for Payer: Zelis Auto |
$540.00
|
| Rate for Payer: Zelis Worker's Compensation |
$368.55
|
|
|
ATTACH BLADDER/URETHRA
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 51841
|
| Hospital Charge Code |
6151841
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.44 |
| Max. Negotiated Rate |
$1,525.70 |
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$1,365.10
|
| Rate for Payer: First Health Commercial |
$1,445.40
|
| Rate for Payer: First Health Workers Compensation |
$620.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.40
|
| Rate for Payer: GEHA Commercial |
$1,124.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.40
|
| Rate for Payer: Multiplan All |
$1,461.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,525.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,493.58
|
| Rate for Payer: Zelis Auto |
$642.40
|
| Rate for Payer: Zelis Worker's Compensation |
$438.44
|
|
|
ATTACH BLADDER/URETHRA
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 51841
|
| Hospital Charge Code |
6151841
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.50 |
| Max. Negotiated Rate |
$1,525.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$1,365.10
|
| Rate for Payer: First Health Commercial |
$1,445.40
|
| Rate for Payer: First Health Workers Compensation |
$620.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.40
|
| Rate for Payer: GEHA Commercial |
$1,284.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.40
|
| Rate for Payer: Humana ChoiceCare |
$417.56
|
| Rate for Payer: Multiplan All |
$1,461.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$963.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,525.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,413.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$401.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,493.58
|
| Rate for Payer: Zelis Auto |
$642.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$803.00
|
| Rate for Payer: Zelis Worker's Compensation |
$438.44
|
|
|
ATTACH BLADDER/URETHRA
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 51840
|
| Hospital Charge Code |
6151840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,147.50
|
| Rate for Payer: First Health Commercial |
$1,215.00
|
| Rate for Payer: First Health Workers Compensation |
$521.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.00
|
| Rate for Payer: GEHA Commercial |
$1,080.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.00
|
| Rate for Payer: Humana ChoiceCare |
$351.00
|
| Rate for Payer: Multiplan All |
$1,228.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$810.00
|
| Rate for Payer: OMNI Networks Commercial |
$945.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,282.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,012.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,188.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,255.50
|
| Rate for Payer: Zelis Auto |
$540.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$675.00
|
| Rate for Payer: Zelis Worker's Compensation |
$368.55
|
|
|
AUDIOMETERS 1000+DIGITAL W/PRINTER
|
Facility
|
IP
|
$393.00
|
|
| Hospital Charge Code |
90030902
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
AUDIOMETERS 1000+DIGITAL W/PRINTER
|
Facility
|
OP
|
$393.00
|
|
| Hospital Charge Code |
90030902
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$314.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Humana ChoiceCare |
$102.18
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$235.80
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$345.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$196.50
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
AUTGRFT IMPLNT KNEE W/SCOPE
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
CPT 29866
|
| Hospital Charge Code |
6129866
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$585.59 |
| Max. Negotiated Rate |
$2,037.75 |
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna Commercial |
$1,823.25
|
| Rate for Payer: First Health Commercial |
$1,930.50
|
| Rate for Payer: First Health Workers Compensation |
$828.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,930.50
|
| Rate for Payer: GEHA Commercial |
$1,501.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,930.50
|
| Rate for Payer: Multiplan All |
$1,951.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,501.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,930.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,037.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,608.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,994.85
|
| Rate for Payer: Zelis Auto |
$858.00
|
| Rate for Payer: Zelis Worker's Compensation |
$585.59
|
|
|
AUTGRFT IMPLNT KNEE W/SCOPE
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
CPT 29866
|
| Hospital Charge Code |
6129866
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$585.59 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,287.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna Commercial |
$1,823.25
|
| Rate for Payer: First Health Commercial |
$1,930.50
|
| Rate for Payer: First Health Workers Compensation |
$828.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,930.50
|
| Rate for Payer: GEHA Commercial |
$1,716.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,930.50
|
| 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 |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,951.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,501.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,930.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,037.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,608.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,994.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$858.00
|
| 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 |
$585.59
|
|
|
AUTO BF CELL COUNT
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
2209052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.72
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$9.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$4.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$5.19
|
| Rate for Payer: Humana Medicare Advantage |
$4.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.72
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.02
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.44
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.63
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.72
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.66
|
| Rate for Payer: Zelis Worker's Compensation |
$6.54
|
|
|
AUTO BF CELL COUNT
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
2209052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$9.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6.54
|
|
|
AUTOCHONDROCYTE IMPLANT KNEE
|
Facility
|
IP
|
$3,421.00
|
|
|
Service Code
|
CPT 27412
|
| Hospital Charge Code |
6127412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$933.93 |
| Max. Negotiated Rate |
$3,249.95 |
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cigna Commercial |
$2,907.85
|
| Rate for Payer: First Health Commercial |
$3,078.90
|
| Rate for Payer: First Health Workers Compensation |
$1,320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,078.90
|
| Rate for Payer: GEHA Commercial |
$2,394.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,078.90
|
| Rate for Payer: Multiplan All |
$3,113.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,394.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,078.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,249.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,565.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,181.53
|
| Rate for Payer: Zelis Auto |
$1,368.40
|
| Rate for Payer: Zelis Worker's Compensation |
$933.93
|
|
|
AUTOCHONDROCYTE IMPLANT KNEE
|
Facility
|
OP
|
$3,421.00
|
|
|
Service Code
|
CPT 27412
|
| Hospital Charge Code |
6127412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$933.93 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,052.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cigna Commercial |
$2,907.85
|
| Rate for Payer: First Health Commercial |
$3,078.90
|
| Rate for Payer: First Health Workers Compensation |
$1,320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,078.90
|
| Rate for Payer: GEHA Commercial |
$2,736.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,078.90
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$3,113.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$2,394.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,078.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,249.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$2,565.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,181.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$1,368.40
|
| 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 |
$933.93
|
|
|
AUTOTRANSPLANT PARATHYROID
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 60512
|
| Hospital Charge Code |
6160512
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: First Health Workers Compensation |
$248.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$450.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Worker's Compensation |
$175.81
|
|
|
AUTOTRANSPLANT PARATHYROID
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 60512
|
| Hospital Charge Code |
6160512
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$2,364.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$386.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: First Health Workers Compensation |
$248.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$167.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$386.40
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$566.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$322.00
|
| Rate for Payer: Zelis Worker's Compensation |
$175.81
|
|
|
AV FUSE, UPPR ARM, BASILIC
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
CPT 36819
|
| Hospital Charge Code |
6136819
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.34 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$948.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,343.00
|
| Rate for Payer: First Health Commercial |
$1,422.00
|
| Rate for Payer: First Health Workers Compensation |
$610.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,422.00
|
| Rate for Payer: GEHA Commercial |
$1,264.00
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,422.00
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,342.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$1,437.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,106.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,422.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,859.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,342.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,501.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,185.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,342.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,469.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$632.00
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$431.34
|
|
|
AV FUSE, UPPR ARM, BASILIC
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
CPT 36819
|
| Hospital Charge Code |
6136819
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.34 |
| Max. Negotiated Rate |
$1,501.00 |
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,343.00
|
| Rate for Payer: First Health Commercial |
$1,422.00
|
| Rate for Payer: First Health Workers Compensation |
$610.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,422.00
|
| Rate for Payer: GEHA Commercial |
$1,106.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,422.00
|
| Rate for Payer: Multiplan All |
$1,437.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,106.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,422.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,501.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,185.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,469.40
|
| Rate for Payer: Zelis Auto |
$632.00
|
| Rate for Payer: Zelis Worker's Compensation |
$431.34
|
|
|
AV FUSE, UPPR ARM, CEPHALIC
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 36818
|
| Hospital Charge Code |
6136818
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.59 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cigna Commercial |
$1,269.05
|
| Rate for Payer: First Health Commercial |
$1,343.70
|
| Rate for Payer: First Health Workers Compensation |
$576.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,343.70
|
| Rate for Payer: GEHA Commercial |
$1,194.40
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,343.70
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,342.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$1,358.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,045.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,343.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,859.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,342.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,418.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,119.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,342.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,388.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$597.20
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$407.59
|
|
|
AV FUSE, UPPR ARM, CEPHALIC
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 36818
|
| Hospital Charge Code |
6136818
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.59 |
| Max. Negotiated Rate |
$1,418.35 |
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cigna Commercial |
$1,269.05
|
| Rate for Payer: First Health Commercial |
$1,343.70
|
| Rate for Payer: First Health Workers Compensation |
$576.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,343.70
|
| Rate for Payer: GEHA Commercial |
$1,045.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,343.70
|
| Rate for Payer: Multiplan All |
$1,358.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,045.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,343.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,418.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,119.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,388.49
|
| Rate for Payer: Zelis Auto |
$597.20
|
| Rate for Payer: Zelis Worker's Compensation |
$407.59
|
|
|
AV FUSION DIRECT ANY SITE
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
CPT 36821
|
| Hospital Charge Code |
6136821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.66 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$858.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$1,216.35
|
| Rate for Payer: First Health Commercial |
$1,287.90
|
| Rate for Payer: First Health Workers Compensation |
$552.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,287.90
|
| Rate for Payer: GEHA Commercial |
$1,144.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,287.90
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,342.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,302.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,001.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,287.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,859.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,342.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,359.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$1,073.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,342.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,330.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$572.40
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$390.66
|
|
|
AV FUSION DIRECT ANY SITE
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
CPT 36821
|
| Hospital Charge Code |
6136821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.66 |
| Max. Negotiated Rate |
$1,359.45 |
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$1,216.35
|
| Rate for Payer: First Health Commercial |
$1,287.90
|
| Rate for Payer: First Health Workers Compensation |
$552.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,287.90
|
| Rate for Payer: GEHA Commercial |
$1,001.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,287.90
|
| Rate for Payer: Multiplan All |
$1,302.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,001.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,287.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,359.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,073.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,330.83
|
| Rate for Payer: Zelis Auto |
$572.40
|
| Rate for Payer: Zelis Worker's Compensation |
$390.66
|
|
|
AVL 4.5MM INFERIOR DRILL
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90032041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,561.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
|
|
AVL 4.5MM INFERIOR DRILL
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90032041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.50 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,784.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Humana ChoiceCare |
$579.80
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,338.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,962.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$557.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,115.00
|
|
|
AVL 6MM CAN.
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90032037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.50 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,784.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Humana ChoiceCare |
$579.80
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,338.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,962.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$557.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,115.00
|
|
|
AVL 6MM CAN.
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90032037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,561.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
|
|
AVL 6MM SUPERIOR
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90032038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,561.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
|
