|
AVULSION NAIL PLATE PART/COMPL SIMPLE 1
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
20300019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
AVULSION NAIL PLATE PART/COMPL SIMPLE 1
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
1900019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$527.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$703.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
1900020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$395.25
|
| Rate for Payer: First Health Commercial |
$418.50
|
| Rate for Payer: First Health Workers Compensation |
$179.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$418.50
|
| Rate for Payer: GEHA Commercial |
$372.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$418.50
|
| Rate for Payer: Humana ChoiceCare |
$120.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$423.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$279.00
|
| Rate for Payer: OMNI Networks Commercial |
$325.50
|
| Rate for Payer: One Health Plan PPO/POS |
$418.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$441.75
|
| Rate for Payer: Three Rivers Provider Network All |
$348.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$409.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$432.45
|
| Rate for Payer: Zelis Auto |
$186.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$232.50
|
| Rate for Payer: Zelis Worker's Compensation |
$126.94
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
6111732
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$21.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$15.29
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
20300020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
IP
|
$492.00
|
|
| Hospital Charge Code |
8150041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
20300020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$25.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$58.80
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.00
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
OP
|
$492.00
|
|
| Hospital Charge Code |
8150041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$393.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Humana ChoiceCare |
$127.92
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$295.20
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$432.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$246.00
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
6111732
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$88.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$21.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.60
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.29
|
|
|
AVULSION NAIL PLATE PART/COMP SIMP EA AD
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
1900020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$395.25
|
| Rate for Payer: First Health Commercial |
$418.50
|
| Rate for Payer: First Health Workers Compensation |
$179.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$418.50
|
| Rate for Payer: GEHA Commercial |
$325.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$418.50
|
| Rate for Payer: Multiplan All |
$423.15
|
| Rate for Payer: OMNI Networks Commercial |
$325.50
|
| Rate for Payer: One Health Plan PPO/POS |
$418.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$441.75
|
| Rate for Payer: Three Rivers Provider Network All |
$348.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$432.45
|
| Rate for Payer: Zelis Auto |
$186.00
|
| Rate for Payer: Zelis Worker's Compensation |
$126.94
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$377.34
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: First Health Workers Compensation |
$242.82
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$171.69
|
|
|
AVULSN NAIL PLTE PART/COMP SIMPLE EA ADD
|
Facility
|
IP
|
$477.50
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
9611732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$453.62 |
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$405.88
|
| Rate for Payer: First Health Commercial |
$429.75
|
| Rate for Payer: First Health Workers Compensation |
$184.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.75
|
| Rate for Payer: GEHA Commercial |
$334.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.75
|
| Rate for Payer: Multiplan All |
$434.52
|
| Rate for Payer: OMNI Networks Commercial |
$334.25
|
| Rate for Payer: One Health Plan PPO/POS |
$429.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.62
|
| Rate for Payer: Three Rivers Provider Network All |
$358.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$444.07
|
| Rate for Payer: Zelis Auto |
$191.00
|
| Rate for Payer: Zelis Worker's Compensation |
$130.36
|
|
|
AVULSN NAIL PLTE PART/COMP SIMPLE EA ADD
|
Facility
|
OP
|
$477.50
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
9611732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$453.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$405.88
|
| Rate for Payer: First Health Commercial |
$429.75
|
| Rate for Payer: First Health Workers Compensation |
$184.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.75
|
| Rate for Payer: GEHA Commercial |
$382.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.75
|
| Rate for Payer: Humana ChoiceCare |
$124.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$434.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.50
|
| Rate for Payer: OMNI Networks Commercial |
$334.25
|
| Rate for Payer: One Health Plan PPO/POS |
$429.75
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.62
|
| Rate for Payer: Three Rivers Provider Network All |
$358.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$420.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$444.07
|
| Rate for Payer: Zelis Auto |
$191.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.75
|
| Rate for Payer: Zelis Worker's Compensation |
$130.36
|
|
|
AXIS FLEX DISPOSABLE URETERSCOPE
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
CPT C1747
|
| Hospital Charge Code |
7001728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.40 |
| Max. Negotiated Rate |
$2,955.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,488.80
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$2,644.35
|
| Rate for Payer: First Health Commercial |
$2,799.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,799.90
|
| Rate for Payer: GEHA Commercial |
$2,177.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,799.90
|
| Rate for Payer: Multiplan All |
$2,831.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,177.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,799.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,955.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,333.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,893.23
|
| Rate for Payer: Zelis Auto |
$1,244.40
|
|
|
AXIS FLEX DISPOSABLE URETERSCOPE
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
CPT C1747
|
| Hospital Charge Code |
7001728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$2,955.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,866.60
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$2,644.35
|
| Rate for Payer: First Health Commercial |
$2,799.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,799.90
|
| Rate for Payer: GEHA Commercial |
$2,488.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,799.90
|
| Rate for Payer: Humana ChoiceCare |
$808.86
|
| Rate for Payer: Multiplan All |
$2,831.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,866.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,177.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,799.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,955.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,333.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,737.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$777.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,893.23
|
| Rate for Payer: Zelis Auto |
$1,244.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,555.50
|
|
|
AZITHROMYCIN 250 MG TAB
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 00781577631
|
| Hospital Charge Code |
3300082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
AZITHROMYCIN 250 MG TAB
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 00781577631
|
| Hospital Charge Code |
3300082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
AZITHROMYCIN 300 MG/15 ML
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
NDC 42806014731
|
| Hospital Charge Code |
3300080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: First Health Commercial |
$72.00
|
| Rate for Payer: First Health Workers Compensation |
$30.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.00
|
| Rate for Payer: GEHA Commercial |
$56.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.00
|
| Rate for Payer: Multiplan All |
$72.80
|
| Rate for Payer: OMNI Networks Commercial |
$56.00
|
| Rate for Payer: One Health Plan PPO/POS |
$72.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.00
|
| Rate for Payer: Three Rivers Provider Network All |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.40
|
| Rate for Payer: Zelis Auto |
$32.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.84
|
|
|
AZITHROMYCIN 300 MG/15 ML
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
NDC 42806014731
|
| Hospital Charge Code |
3300080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: First Health Commercial |
$72.00
|
| Rate for Payer: First Health Workers Compensation |
$30.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.00
|
| Rate for Payer: GEHA Commercial |
$64.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.00
|
| Rate for Payer: Humana ChoiceCare |
$20.80
|
| Rate for Payer: Multiplan All |
$72.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.00
|
| Rate for Payer: OMNI Networks Commercial |
$56.00
|
| Rate for Payer: One Health Plan PPO/POS |
$72.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.00
|
| Rate for Payer: Three Rivers Provider Network All |
$60.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$70.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.40
|
| Rate for Payer: Zelis Auto |
$32.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.84
|
|
|
AZITHROMYCIN 500 MG IV
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
3300079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$18.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$2.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.20
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.83
|
|
|
AZITHROMYCIN 500 MG IV
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
3300079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$18.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$32.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Worker's Compensation |
$12.83
|
|
|
AZITHROMYCIN SUSP 200MG/5ML
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
3300081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
AZITHROMYCIN SUSP 200MG/5ML
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
3300081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
BACITRACIN 50,000 UNITS - OR
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 63323032931
|
| Hospital Charge Code |
3300083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$36.55
|
| Rate for Payer: First Health Commercial |
$38.70
|
| Rate for Payer: First Health Workers Compensation |
$16.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$38.70
|
| Rate for Payer: GEHA Commercial |
$34.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$38.70
|
| Rate for Payer: Humana ChoiceCare |
$11.18
|
| Rate for Payer: Multiplan All |
$39.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.80
|
| Rate for Payer: OMNI Networks Commercial |
$30.10
|
| Rate for Payer: One Health Plan PPO/POS |
$38.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$40.85
|
| Rate for Payer: Three Rivers Provider Network All |
$32.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$37.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.99
|
| Rate for Payer: Zelis Auto |
$17.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.74
|
|
|
BACITRACIN 50,000 UNITS - OR
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 63323032931
|
| Hospital Charge Code |
3300083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$36.55
|
| Rate for Payer: First Health Commercial |
$38.70
|
| Rate for Payer: First Health Workers Compensation |
$16.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$38.70
|
| Rate for Payer: GEHA Commercial |
$30.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$38.70
|
| Rate for Payer: Multiplan All |
$39.13
|
| Rate for Payer: OMNI Networks Commercial |
$30.10
|
| Rate for Payer: One Health Plan PPO/POS |
$38.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$40.85
|
| Rate for Payer: Three Rivers Provider Network All |
$32.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.99
|
| Rate for Payer: Zelis Auto |
$17.20
|
| Rate for Payer: Zelis Worker's Compensation |
$11.74
|
|
