|
PT WHEELCHAIR MNGMT TRA
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
4310006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.45
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$60.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$42.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$33.11
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.20
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$33.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.56
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.49
|
|
|
PT WHEELCHAIR MNGMT TRA
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
4310006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
PT WORK HARDENING ADDL HR
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
4310012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
PT WORK HARDENING ADDL HR
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
4310012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$79.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Humana ChoiceCare |
$197.86
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$456.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$669.68
|
| Rate for Payer: United Healthcare Commercial |
$646.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$380.50
|
| Rate for Payer: Zelis Worker's Compensation |
$56.03
|
|
|
PT WOUNDCARE NONSELECTV
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
4303209
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$466.45 |
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$417.35
|
| Rate for Payer: First Health Commercial |
$441.90
|
| Rate for Payer: First Health Workers Compensation |
$189.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.90
|
| Rate for Payer: GEHA Commercial |
$343.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.90
|
| Rate for Payer: Multiplan All |
$446.81
|
| Rate for Payer: OMNI Networks Commercial |
$343.70
|
| Rate for Payer: One Health Plan PPO/POS |
$441.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$466.45
|
| Rate for Payer: Three Rivers Provider Network All |
$368.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$456.63
|
| Rate for Payer: Zelis Auto |
$196.40
|
| Rate for Payer: Zelis Worker's Compensation |
$134.04
|
|
|
PT WOUNDCARE NONSELECTV
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
4303209
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$466.45 |
| 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 |
$294.60
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$417.35
|
| Rate for Payer: First Health Commercial |
$441.90
|
| Rate for Payer: First Health Workers Compensation |
$64.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.90
|
| Rate for Payer: GEHA Commercial |
$392.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.90
|
| 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 |
$446.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$343.70
|
| Rate for Payer: One Health Plan PPO/POS |
$441.90
|
| 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 |
$466.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$368.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Commercial |
$417.35
|
| 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 |
$456.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$196.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.76
|
|
|
PULMONARY COMPLIANCE STUDY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 94750
|
| Hospital Charge Code |
4094750
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
PULMONARY COMPLIANCE STUDY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 94750
|
| Hospital Charge Code |
4094750
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
PULMONARY STRESS TESTING (6MWT)
|
Facility
|
IP
|
$535.80
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4094618
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$146.27 |
| Max. Negotiated Rate |
$509.01 |
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cigna Commercial |
$455.43
|
| Rate for Payer: First Health Commercial |
$482.22
|
| Rate for Payer: First Health Workers Compensation |
$206.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.22
|
| Rate for Payer: GEHA Commercial |
$375.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.22
|
| Rate for Payer: Multiplan All |
$487.58
|
| Rate for Payer: OMNI Networks Commercial |
$375.06
|
| Rate for Payer: One Health Plan PPO/POS |
$482.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.01
|
| Rate for Payer: Three Rivers Provider Network All |
$401.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.29
|
| Rate for Payer: Zelis Auto |
$214.32
|
| Rate for Payer: Zelis Worker's Compensation |
$146.27
|
|
|
PULMONARY STRESS TESTING (6MWT)
|
Facility
|
OP
|
$535.80
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4094618
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$509.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$157.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$157.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$124.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cigna Commercial |
$455.43
|
| Rate for Payer: First Health Commercial |
$482.22
|
| Rate for Payer: First Health Workers Compensation |
$206.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.22
|
| Rate for Payer: GEHA Commercial |
$428.64
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.22
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$127.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$487.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$375.06
|
| Rate for Payer: One Health Plan PPO/POS |
$482.22
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$147.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$127.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$401.85
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$455.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$214.32
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$146.27
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
20300146
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
21600216
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$47.06
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.60
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
21600216
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
6111105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: First Health Workers Compensation |
$191.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$396.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Humana ChoiceCare |
$128.70
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$297.00
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$435.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: Zelis Auto |
$198.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$247.50
|
| Rate for Payer: Zelis Worker's Compensation |
$135.13
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
OP
|
$586.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
1999251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.50 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.60
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$498.10
|
| Rate for Payer: First Health Commercial |
$527.40
|
| Rate for Payer: First Health Workers Compensation |
$226.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$527.40
|
| Rate for Payer: GEHA Commercial |
$468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$527.40
|
| Rate for Payer: Humana ChoiceCare |
$152.36
|
| Rate for Payer: Multiplan All |
$533.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$351.60
|
| Rate for Payer: OMNI Networks Commercial |
$410.20
|
| Rate for Payer: One Health Plan PPO/POS |
$527.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$556.70
|
| Rate for Payer: Three Rivers Provider Network All |
$439.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$515.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.98
|
| Rate for Payer: Zelis Auto |
$234.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$293.00
|
| Rate for Payer: Zelis Worker's Compensation |
$159.98
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
20300146
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$47.06
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.60
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9611105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$222.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$461.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Humana ChoiceCare |
$150.02
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$346.20
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$507.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$288.50
|
| Rate for Payer: Zelis Worker's Compensation |
$157.52
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
6111105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.13 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: First Health Workers Compensation |
$191.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$346.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: Zelis Auto |
$198.00
|
| Rate for Payer: Zelis Worker's Compensation |
$135.13
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
OP
|
$162.39
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
8511118
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$154.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.43
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cigna Commercial |
$138.03
|
| Rate for Payer: First Health Commercial |
$146.15
|
| Rate for Payer: First Health Workers Compensation |
$62.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.15
|
| Rate for Payer: GEHA Commercial |
$129.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.15
|
| Rate for Payer: Humana ChoiceCare |
$42.22
|
| Rate for Payer: Multiplan All |
$147.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.43
|
| Rate for Payer: OMNI Networks Commercial |
$113.67
|
| Rate for Payer: One Health Plan PPO/POS |
$146.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.27
|
| Rate for Payer: Three Rivers Provider Network All |
$121.79
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.02
|
| Rate for Payer: Zelis Auto |
$64.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.19
|
| Rate for Payer: Zelis Worker's Compensation |
$44.33
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
OP
|
$162.39
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
7211105
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$154.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.43
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cigna Commercial |
$138.03
|
| Rate for Payer: First Health Commercial |
$146.15
|
| Rate for Payer: First Health Workers Compensation |
$62.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.15
|
| Rate for Payer: GEHA Commercial |
$129.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.15
|
| Rate for Payer: Humana ChoiceCare |
$42.22
|
| Rate for Payer: Multiplan All |
$147.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.43
|
| Rate for Payer: OMNI Networks Commercial |
$113.67
|
| Rate for Payer: One Health Plan PPO/POS |
$146.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.27
|
| Rate for Payer: Three Rivers Provider Network All |
$121.79
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.02
|
| Rate for Payer: Zelis Auto |
$64.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.19
|
| Rate for Payer: Zelis Worker's Compensation |
$44.33
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
IP
|
$586.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
1999251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$498.10
|
| Rate for Payer: First Health Commercial |
$527.40
|
| Rate for Payer: First Health Workers Compensation |
$226.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$527.40
|
| Rate for Payer: GEHA Commercial |
$410.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$527.40
|
| Rate for Payer: Multiplan All |
$533.26
|
| Rate for Payer: OMNI Networks Commercial |
$410.20
|
| Rate for Payer: One Health Plan PPO/POS |
$527.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$556.70
|
| Rate for Payer: Three Rivers Provider Network All |
$439.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.98
|
| Rate for Payer: Zelis Auto |
$234.40
|
| Rate for Payer: Zelis Worker's Compensation |
$159.98
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9611105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.52 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$222.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$403.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Worker's Compensation |
$157.52
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
IP
|
$162.39
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
8511118
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$154.27 |
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cigna Commercial |
$138.03
|
| Rate for Payer: First Health Commercial |
$146.15
|
| Rate for Payer: First Health Workers Compensation |
$62.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.15
|
| Rate for Payer: GEHA Commercial |
$113.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.15
|
| Rate for Payer: Multiplan All |
$147.77
|
| Rate for Payer: OMNI Networks Commercial |
$113.67
|
| Rate for Payer: One Health Plan PPO/POS |
$146.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.27
|
| Rate for Payer: Three Rivers Provider Network All |
$121.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.02
|
| Rate for Payer: Zelis Auto |
$64.96
|
| Rate for Payer: Zelis Worker's Compensation |
$44.33
|
|
|
PUNCH BIOPSY SKIN EA SEP/ADDL LESION
|
Facility
|
IP
|
$162.39
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
7211105
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$154.27 |
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cigna Commercial |
$138.03
|
| Rate for Payer: First Health Commercial |
$146.15
|
| Rate for Payer: First Health Workers Compensation |
$62.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.15
|
| Rate for Payer: GEHA Commercial |
$113.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.15
|
| Rate for Payer: Multiplan All |
$147.77
|
| Rate for Payer: OMNI Networks Commercial |
$113.67
|
| Rate for Payer: One Health Plan PPO/POS |
$146.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.27
|
| Rate for Payer: Three Rivers Provider Network All |
$121.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.02
|
| Rate for Payer: Zelis Auto |
$64.96
|
| Rate for Payer: Zelis Worker's Compensation |
$44.33
|
|
|
PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$335.10
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
8511117
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$318.35 |
| Rate for Payer: Cash Price |
$201.06
|
| Rate for Payer: Cigna Commercial |
$284.83
|
| Rate for Payer: First Health Commercial |
$301.59
|
| Rate for Payer: First Health Workers Compensation |
$129.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.59
|
| Rate for Payer: GEHA Commercial |
$234.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.59
|
| Rate for Payer: Multiplan All |
$304.94
|
| Rate for Payer: OMNI Networks Commercial |
$234.57
|
| Rate for Payer: One Health Plan PPO/POS |
$301.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.35
|
| Rate for Payer: Three Rivers Provider Network All |
$251.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.64
|
| Rate for Payer: Zelis Auto |
$134.04
|
| Rate for Payer: Zelis Worker's Compensation |
$91.48
|
|
