|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
21700040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$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: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| 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: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| 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 |
$14.17
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
20399224
|
|
Hospital Revenue Code
|
424
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
7999251
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
12099221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.55
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$16.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$11.97
|
| Rate for Payer: GEHA Commercial |
$8.55
|
| Rate for Payer: GEHA Medicare |
$8.55
|
| Rate for Payer: Health Net Federal Services Government |
$8.55
|
| Rate for Payer: Humana ChoiceCare |
$9.40
|
| Rate for Payer: Humana Medicare Advantage |
$8.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.55
|
| Rate for Payer: Multiplan All |
$21.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$26.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.98
|
| Rate for Payer: OMNI Networks Commercial |
$19.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.11
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.55
|
| Rate for Payer: Zelis Medicare |
$7.27
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8300073
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$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: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| 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: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| 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 |
$14.17
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
25500020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$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: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| 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: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| 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 |
$14.17
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
11099221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.55
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$16.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$11.97
|
| Rate for Payer: GEHA Commercial |
$8.55
|
| Rate for Payer: GEHA Medicare |
$8.55
|
| Rate for Payer: Health Net Federal Services Government |
$8.55
|
| Rate for Payer: Humana ChoiceCare |
$9.40
|
| Rate for Payer: Humana Medicare Advantage |
$8.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.55
|
| Rate for Payer: Multiplan All |
$21.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$26.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.98
|
| Rate for Payer: OMNI Networks Commercial |
$19.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.11
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.55
|
| Rate for Payer: Zelis Medicare |
$7.27
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8900032
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8300073
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
21600020
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$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: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| 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: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| 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 |
$14.17
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
20399224
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$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: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| 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: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| 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 Commercial |
$32.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.17
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8500015
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8250031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$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: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| 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: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| 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 Commercial |
$32.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.17
|
| 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
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8700010
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
REMOVAL ALLOGRAFT PANCREAS
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 48556
|
| Hospital Charge Code |
6148556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$2,519.40 |
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna Commercial |
$2,254.20
|
| Rate for Payer: First Health Commercial |
$2,386.80
|
| Rate for Payer: First Health Workers Compensation |
$1,023.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,386.80
|
| Rate for Payer: GEHA Commercial |
$1,856.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,386.80
|
| Rate for Payer: Multiplan All |
$2,413.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,856.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,386.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,519.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,989.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,466.36
|
| Rate for Payer: Zelis Auto |
$1,060.80
|
| Rate for Payer: Zelis Worker's Compensation |
$724.00
|
|
|
REMOVAL ALLOGRAFT PANCREAS
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 48556
|
| Hospital Charge Code |
6148556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,519.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna Commercial |
$2,254.20
|
| Rate for Payer: First Health Commercial |
$2,386.80
|
| Rate for Payer: First Health Workers Compensation |
$1,023.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,386.80
|
| Rate for Payer: GEHA Commercial |
$2,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,386.80
|
| Rate for Payer: Humana ChoiceCare |
$689.52
|
| Rate for Payer: Multiplan All |
$2,413.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,591.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,856.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,386.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,519.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,989.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,333.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,466.36
|
| Rate for Payer: Zelis Auto |
$1,060.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,326.00
|
| Rate for Payer: Zelis Worker's Compensation |
$724.00
|
|
|
REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Facility
|
IP
|
$766.56
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
20367938
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.27 |
| Max. Negotiated Rate |
$728.23 |
| Rate for Payer: Cash Price |
$459.94
|
| Rate for Payer: Cigna Commercial |
$651.58
|
| Rate for Payer: First Health Commercial |
$689.90
|
| Rate for Payer: First Health Workers Compensation |
$295.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.90
|
| Rate for Payer: GEHA Commercial |
$536.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.90
|
| Rate for Payer: Multiplan All |
$697.57
|
| Rate for Payer: OMNI Networks Commercial |
$536.59
|
| Rate for Payer: One Health Plan PPO/POS |
$689.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$728.23
|
| Rate for Payer: Three Rivers Provider Network All |
$574.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.90
|
| Rate for Payer: Zelis Auto |
$306.62
|
| Rate for Payer: Zelis Worker's Compensation |
$209.27
|
|
|
REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
21600157
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$93.91 |
| Max. Negotiated Rate |
$567.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$447.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$447.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$354.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$283.85
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: First Health Workers Compensation |
$132.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$275.20
|
| Rate for Payer: GEHA Medicare |
$283.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Humana ChoiceCare |
$312.24
|
| Rate for Payer: Humana Medicare Advantage |
$283.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$476.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$361.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$283.85
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$482.55
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$417.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$361.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$283.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$567.70
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$278.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$361.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$283.85
|
| Rate for Payer: Zelis Auto |
$137.60
|
| Rate for Payer: Zelis Medicare |
$241.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$340.62
|
| Rate for Payer: Zelis Worker's Compensation |
$93.91
|
|
|
REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Facility
|
OP
|
$766.56
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
20367938
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.27 |
| Max. Negotiated Rate |
$728.23 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$447.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$459.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$447.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$354.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$283.85
|
| Rate for Payer: Cash Price |
$459.94
|
| Rate for Payer: Cash Price |
$459.94
|
| Rate for Payer: Cigna Commercial |
$651.58
|
| Rate for Payer: First Health Commercial |
$689.90
|
| Rate for Payer: First Health Workers Compensation |
$295.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.90
|
| Rate for Payer: GEHA Commercial |
$613.25
|
| Rate for Payer: GEHA Medicare |
$283.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.90
|
| Rate for Payer: Humana ChoiceCare |
$312.24
|
| Rate for Payer: Humana Medicare Advantage |
$283.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$476.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$361.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$283.85
|
| Rate for Payer: Multiplan All |
$697.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$482.55
|
| Rate for Payer: OMNI Networks Commercial |
$536.59
|
| Rate for Payer: One Health Plan PPO/POS |
$689.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$417.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$361.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$283.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$728.23
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$567.70
|
| Rate for Payer: Three Rivers Provider Network All |
$574.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$278.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$361.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$283.85
|
| Rate for Payer: Zelis Auto |
$306.62
|
| Rate for Payer: Zelis Medicare |
$241.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$340.62
|
| Rate for Payer: Zelis Worker's Compensation |
$209.27
|
|
|
REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
21600157
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$93.91 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: First Health Workers Compensation |
$132.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: Zelis Auto |
$137.60
|
| Rate for Payer: Zelis Worker's Compensation |
$93.91
|
|
|
REMOVAL FB EXT EYE; CORNL W/LAMP
|
Facility
|
OP
|
$2,329.00
|
|
| Hospital Charge Code |
8165435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.25 |
| Max. Negotiated Rate |
$2,212.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,397.40
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$1,979.65
|
| Rate for Payer: First Health Commercial |
$2,096.10
|
| Rate for Payer: First Health Workers Compensation |
$899.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,096.10
|
| Rate for Payer: GEHA Commercial |
$1,863.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,096.10
|
| Rate for Payer: Humana ChoiceCare |
$605.54
|
| Rate for Payer: Multiplan All |
$2,119.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,397.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,630.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,096.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,212.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,746.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,049.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$582.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,165.97
|
| Rate for Payer: Zelis Auto |
$931.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,164.50
|
| Rate for Payer: Zelis Worker's Compensation |
$635.82
|
|
|
REMOVAL FB EXT EYE; CORNL W/LAMP
|
Facility
|
IP
|
$2,329.00
|
|
| Hospital Charge Code |
8165435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$635.82 |
| Max. Negotiated Rate |
$2,212.55 |
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$1,979.65
|
| Rate for Payer: First Health Commercial |
$2,096.10
|
| Rate for Payer: First Health Workers Compensation |
$899.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,096.10
|
| Rate for Payer: GEHA Commercial |
$1,630.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,096.10
|
| Rate for Payer: Multiplan All |
$2,119.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,630.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,096.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,212.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,746.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,165.97
|
| Rate for Payer: Zelis Auto |
$931.60
|
| Rate for Payer: Zelis Worker's Compensation |
$635.82
|
|
|
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
21600158
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$51.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$93.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Worker's Compensation |
$36.31
|
|
|
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
21600158
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$51.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| 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 |
$122.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$141.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$36.31
|
|
|
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Facility
|
OP
|
$80.04
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
7265205
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cigna Commercial |
$68.03
|
| Rate for Payer: First Health Commercial |
$72.04
|
| Rate for Payer: First Health Workers Compensation |
$30.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.04
|
| Rate for Payer: GEHA Commercial |
$64.03
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.04
|
| 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 |
$122.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$72.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$56.03
|
| Rate for Payer: One Health Plan PPO/POS |
$72.04
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$141.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$60.03
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$32.02
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$21.85
|
|
