|
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Facility
|
IP
|
$80.04
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
8565205
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$76.04 |
| 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 |
$56.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.04
|
| Rate for Payer: Multiplan All |
$72.84
|
| Rate for Payer: OMNI Networks Commercial |
$56.03
|
| Rate for Payer: One Health Plan PPO/POS |
$72.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.04
|
| Rate for Payer: Three Rivers Provider Network All |
$60.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.44
|
| Rate for Payer: Zelis Auto |
$32.02
|
| Rate for Payer: Zelis Worker's Compensation |
$21.85
|
|
|
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Facility
|
OP
|
$80.04
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
8565205
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Facility
|
IP
|
$80.04
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
7265205
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$76.04 |
| 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 |
$56.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.04
|
| Rate for Payer: Multiplan All |
$72.84
|
| Rate for Payer: OMNI Networks Commercial |
$56.03
|
| Rate for Payer: One Health Plan PPO/POS |
$72.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.04
|
| Rate for Payer: Three Rivers Provider Network All |
$60.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.44
|
| Rate for Payer: Zelis Auto |
$32.02
|
| Rate for Payer: Zelis Worker's Compensation |
$21.85
|
|
|
REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Facility
|
OP
|
$1,411.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
21600493
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$846.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: First Health Workers Compensation |
$544.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$1,128.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$564.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$385.20
|
|
|
REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
6154115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$237.51 |
| Max. Negotiated Rate |
$826.50 |
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$739.50
|
| Rate for Payer: First Health Commercial |
$783.00
|
| Rate for Payer: First Health Workers Compensation |
$335.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.00
|
| Rate for Payer: GEHA Commercial |
$609.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.00
|
| Rate for Payer: Multiplan All |
$791.70
|
| Rate for Payer: OMNI Networks Commercial |
$609.00
|
| Rate for Payer: One Health Plan PPO/POS |
$783.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$826.50
|
| Rate for Payer: Three Rivers Provider Network All |
$652.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$809.10
|
| Rate for Payer: Zelis Auto |
$348.00
|
| Rate for Payer: Zelis Worker's Compensation |
$237.51
|
|
|
REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Facility
|
IP
|
$1,411.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
21600493
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: First Health Workers Compensation |
$544.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$987.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
| Rate for Payer: Zelis Worker's Compensation |
$385.20
|
|
|
REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
6154115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$237.51 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$739.50
|
| Rate for Payer: First Health Commercial |
$783.00
|
| Rate for Payer: First Health Workers Compensation |
$335.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.00
|
| Rate for Payer: GEHA Commercial |
$696.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.00
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$791.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$609.00
|
| Rate for Payer: One Health Plan PPO/POS |
$783.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$826.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$652.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$809.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$348.00
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$237.51
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
OP
|
$1,807.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
21600489
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$493.31 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,084.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cigna Commercial |
$1,535.95
|
| Rate for Payer: First Health Commercial |
$1,626.30
|
| Rate for Payer: First Health Workers Compensation |
$697.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,626.30
|
| Rate for Payer: GEHA Commercial |
$1,445.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,626.30
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,644.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,626.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,716.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,355.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,680.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$722.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$493.31
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
IP
|
$1,807.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
21600489
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$493.31 |
| Max. Negotiated Rate |
$1,716.65 |
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cigna Commercial |
$1,535.95
|
| Rate for Payer: First Health Commercial |
$1,626.30
|
| Rate for Payer: First Health Workers Compensation |
$697.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,626.30
|
| Rate for Payer: GEHA Commercial |
$1,264.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,626.30
|
| Rate for Payer: Multiplan All |
$1,644.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,626.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,716.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,355.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,680.51
|
| Rate for Payer: Zelis Auto |
$722.80
|
| Rate for Payer: Zelis Worker's Compensation |
$493.31
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
IP
|
$2,421.55
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
8127372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.08 |
| Max. Negotiated Rate |
$2,300.47 |
| Rate for Payer: Cash Price |
$1,452.93
|
| Rate for Payer: Cigna Commercial |
$2,058.32
|
| Rate for Payer: First Health Commercial |
$2,179.39
|
| Rate for Payer: First Health Workers Compensation |
$934.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,179.39
|
| Rate for Payer: GEHA Commercial |
$1,695.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,179.39
|
| Rate for Payer: Multiplan All |
$2,203.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,695.09
|
| Rate for Payer: One Health Plan PPO/POS |
$2,179.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,300.47
|
| Rate for Payer: Three Rivers Provider Network All |
$1,816.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,252.04
|
| Rate for Payer: Zelis Auto |
$968.62
|
| Rate for Payer: Zelis Worker's Compensation |
$661.08
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
6127372
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
6127372
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
OP
|
$2,421.55
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
8127372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.08 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,452.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,452.93
|
| Rate for Payer: Cash Price |
$1,452.93
|
| Rate for Payer: Cigna Commercial |
$2,058.32
|
| Rate for Payer: First Health Commercial |
$2,179.39
|
| Rate for Payer: First Health Workers Compensation |
$934.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,179.39
|
| Rate for Payer: GEHA Commercial |
$1,937.24
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,179.39
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$2,203.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,695.09
|
| Rate for Payer: One Health Plan PPO/POS |
$2,179.39
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,300.47
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,816.16
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,252.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$968.62
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$661.08
|
|
|
REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
6128193
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.62 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: First Health Workers Compensation |
$362.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$658.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| Rate for Payer: Multiplan All |
$855.40
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.00
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$874.20
|
| Rate for Payer: Zelis Auto |
$376.00
|
| Rate for Payer: Zelis Worker's Compensation |
$256.62
|
|
|
REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
6128193
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.62 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: First Health Workers Compensation |
$362.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$752.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$855.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$874.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$376.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$256.62
|
|
|
REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
21600479
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$443.35 |
| Max. Negotiated Rate |
$1,542.80 |
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cigna Commercial |
$1,380.40
|
| Rate for Payer: First Health Commercial |
$1,461.60
|
| Rate for Payer: First Health Workers Compensation |
$627.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,461.60
|
| Rate for Payer: GEHA Commercial |
$1,136.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,461.60
|
| Rate for Payer: Multiplan All |
$1,477.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,136.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,461.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,542.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,510.32
|
| Rate for Payer: Zelis Auto |
$649.60
|
| Rate for Payer: Zelis Worker's Compensation |
$443.35
|
|
|
REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
21600479
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$443.35 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$974.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cigna Commercial |
$1,380.40
|
| Rate for Payer: First Health Commercial |
$1,461.60
|
| Rate for Payer: First Health Workers Compensation |
$627.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,461.60
|
| Rate for Payer: GEHA Commercial |
$1,299.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,461.60
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,477.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,136.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,461.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,542.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,510.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$649.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$443.35
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$3,277.00
|
|
| Hospital Charge Code |
8128190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$819.25 |
| Max. Negotiated Rate |
$3,113.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,966.20
|
| Rate for Payer: Cash Price |
$1,966.20
|
| Rate for Payer: Cigna Commercial |
$2,785.45
|
| Rate for Payer: First Health Commercial |
$2,949.30
|
| Rate for Payer: First Health Workers Compensation |
$1,265.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,949.30
|
| Rate for Payer: GEHA Commercial |
$2,621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,949.30
|
| Rate for Payer: Humana ChoiceCare |
$852.02
|
| Rate for Payer: Multiplan All |
$2,982.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,966.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,293.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,949.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,113.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,457.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,883.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$819.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,047.61
|
| Rate for Payer: Zelis Auto |
$1,310.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,638.50
|
| Rate for Payer: Zelis Worker's Compensation |
$894.62
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$3,277.00
|
|
| Hospital Charge Code |
8128190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$894.62 |
| Max. Negotiated Rate |
$3,113.15 |
| Rate for Payer: Cash Price |
$1,966.20
|
| Rate for Payer: Cigna Commercial |
$2,785.45
|
| Rate for Payer: First Health Commercial |
$2,949.30
|
| Rate for Payer: First Health Workers Compensation |
$1,265.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,949.30
|
| Rate for Payer: GEHA Commercial |
$2,293.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,949.30
|
| Rate for Payer: Multiplan All |
$2,982.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,293.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,949.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,113.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,457.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,047.61
|
| Rate for Payer: Zelis Auto |
$1,310.80
|
| Rate for Payer: Zelis Worker's Compensation |
$894.62
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
21600168
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
6128190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
21600168
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
6128190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
REMOVAL FOREIGN BODY INTRANASAL GEN ANES
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
6130310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
REMOVAL FOREIGN BODY INTRANASAL GEN ANES
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
6130310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
