|
BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$2,274.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
9620220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$620.80 |
| Max. Negotiated Rate |
$2,160.30 |
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cigna Commercial |
$1,932.90
|
| Rate for Payer: First Health Commercial |
$2,046.60
|
| Rate for Payer: First Health Workers Compensation |
$877.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,046.60
|
| Rate for Payer: GEHA Commercial |
$1,591.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,046.60
|
| Rate for Payer: Multiplan All |
$2,069.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,591.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,046.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,160.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,705.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,114.82
|
| Rate for Payer: Zelis Auto |
$909.60
|
| Rate for Payer: Zelis Worker's Compensation |
$620.80
|
|
|
BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
20300101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cigna Commercial |
$424.15
|
| Rate for Payer: First Health Commercial |
$449.10
|
| Rate for Payer: First Health Workers Compensation |
$192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$449.10
|
| Rate for Payer: GEHA Commercial |
$349.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$449.10
|
| Rate for Payer: Multiplan All |
$454.09
|
| Rate for Payer: OMNI Networks Commercial |
$349.30
|
| Rate for Payer: One Health Plan PPO/POS |
$449.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$474.05
|
| Rate for Payer: Three Rivers Provider Network All |
$374.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$464.07
|
| Rate for Payer: Zelis Auto |
$199.60
|
| Rate for Payer: Zelis Worker's Compensation |
$136.23
|
|
|
BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$647.76
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
6120220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.84 |
| Max. Negotiated Rate |
$615.37 |
| Rate for Payer: Cash Price |
$388.66
|
| Rate for Payer: Cigna Commercial |
$550.60
|
| Rate for Payer: First Health Commercial |
$582.98
|
| Rate for Payer: First Health Workers Compensation |
$250.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.98
|
| Rate for Payer: GEHA Commercial |
$453.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.98
|
| Rate for Payer: Multiplan All |
$589.46
|
| Rate for Payer: OMNI Networks Commercial |
$453.43
|
| Rate for Payer: One Health Plan PPO/POS |
$582.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$615.37
|
| Rate for Payer: Three Rivers Provider Network All |
$485.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$602.42
|
| Rate for Payer: Zelis Auto |
$259.10
|
| Rate for Payer: Zelis Worker's Compensation |
$176.84
|
|
|
BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
OP
|
$3,567.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
1920220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$3,388.65 |
| 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 |
$2,140.20
|
| 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 |
$1,569.98
|
| Rate for Payer: Cash Price |
$2,140.20
|
| Rate for Payer: Cash Price |
$2,140.20
|
| Rate for Payer: Cigna Commercial |
$3,031.95
|
| Rate for Payer: First Health Commercial |
$3,210.30
|
| Rate for Payer: First Health Workers Compensation |
$1,377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,210.30
|
| Rate for Payer: GEHA Commercial |
$2,853.60
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,210.30
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$3,245.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,496.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,210.30
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,388.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,675.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,317.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$1,426.80
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$973.79
|
|
|
BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$3,567.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
1920220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$973.79 |
| Max. Negotiated Rate |
$3,388.65 |
| Rate for Payer: Cash Price |
$2,140.20
|
| Rate for Payer: Cigna Commercial |
$3,031.95
|
| Rate for Payer: First Health Commercial |
$3,210.30
|
| Rate for Payer: First Health Workers Compensation |
$1,377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,210.30
|
| Rate for Payer: GEHA Commercial |
$2,496.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,210.30
|
| Rate for Payer: Multiplan All |
$3,245.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,496.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,210.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,388.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,675.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,317.31
|
| Rate for Payer: Zelis Auto |
$1,426.80
|
| Rate for Payer: Zelis Worker's Compensation |
$973.79
|
|
|
BIOPSY, BONE, TROCAR, OR NEEDLE; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS)
|
Facility
|
OP
|
$3,139.96
|
|
|
Service Code
|
CPT 20220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$3,139.96 |
| 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 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 |
$1,569.98
|
| Rate for Payer: First Health Workers Compensation |
$2,020.56
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$1,428.68
|
|
|
BIOPSY BREAST OPEN INCISIONAL
|
Facility
|
IP
|
$8,128.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
7719101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,218.94 |
| Max. Negotiated Rate |
$7,721.60 |
| Rate for Payer: Cash Price |
$4,876.80
|
| Rate for Payer: Cigna Commercial |
$6,908.80
|
| Rate for Payer: First Health Commercial |
$7,315.20
|
| Rate for Payer: First Health Workers Compensation |
$3,138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,315.20
|
| Rate for Payer: GEHA Commercial |
$5,689.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,315.20
|
| Rate for Payer: Multiplan All |
$7,396.48
|
| Rate for Payer: OMNI Networks Commercial |
$5,689.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,315.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,721.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,096.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,559.04
|
| Rate for Payer: Zelis Auto |
$3,251.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,218.94
|
|
|
BIOPSY BREAST OPEN INCISIONAL
|
Facility
|
OP
|
$8,128.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
7719101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,982.57 |
| Max. Negotiated Rate |
$7,721.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,876.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,710.50
|
| Rate for Payer: Cash Price |
$4,876.80
|
| Rate for Payer: Cash Price |
$4,876.80
|
| Rate for Payer: Cigna Commercial |
$6,908.80
|
| Rate for Payer: First Health Commercial |
$7,315.20
|
| Rate for Payer: First Health Workers Compensation |
$4,775.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,315.20
|
| Rate for Payer: GEHA Commercial |
$6,502.40
|
| Rate for Payer: GEHA Medicare |
$3,710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,315.20
|
| Rate for Payer: Humana ChoiceCare |
$4,081.55
|
| Rate for Payer: Humana Medicare Advantage |
$3,710.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,233.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,710.50
|
| Rate for Payer: Multiplan All |
$7,396.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,307.85
|
| Rate for Payer: OMNI Networks Commercial |
$5,689.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,315.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,710.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,721.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,421.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,096.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,636.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,710.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,559.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,710.50
|
| Rate for Payer: Zelis Auto |
$3,251.20
|
| Rate for Payer: Zelis Medicare |
$3,153.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,452.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3,376.55
|
|
|
BIOPSY BREAST OPEN INCISIONAL
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
6119101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
BIOPSY BREAST OPEN INCISIONAL
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
6119101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$7,421.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$343.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,710.50
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$3,710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Humana ChoiceCare |
$4,081.55
|
| Rate for Payer: Humana Medicare Advantage |
$3,710.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,233.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,710.50
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,307.85
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,710.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,421.00
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,636.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,710.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,710.50
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$3,153.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,452.60
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
BIOPSY CERVX SINGL/MULT/EXCIS OF LES SPX
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
6157500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$161.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
BIOPSY CERVX SINGL/MULT/EXCIS OF LES SPX
|
Facility
|
IP
|
$3,403.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
10051704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$929.02 |
| Max. Negotiated Rate |
$3,232.85 |
| Rate for Payer: Cash Price |
$2,041.80
|
| Rate for Payer: Cigna Commercial |
$2,892.55
|
| Rate for Payer: First Health Commercial |
$3,062.70
|
| Rate for Payer: First Health Workers Compensation |
$1,313.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,062.70
|
| Rate for Payer: GEHA Commercial |
$2,382.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,062.70
|
| Rate for Payer: Multiplan All |
$3,096.73
|
| Rate for Payer: OMNI Networks Commercial |
$2,382.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,062.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,232.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,552.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,164.79
|
| Rate for Payer: Zelis Auto |
$1,361.20
|
| Rate for Payer: Zelis Worker's Compensation |
$929.02
|
|
|
BIOPSY CERVX SINGL/MULT/EXCIS OF LES SPX
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
23500018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,687.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$687.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$687.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$544.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$843.73
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$320.00
|
| Rate for Payer: GEHA Medicare |
$843.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Humana ChoiceCare |
$928.10
|
| Rate for Payer: Humana Medicare Advantage |
$843.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,417.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$555.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$843.73
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,434.34
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$641.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$555.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$843.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,687.46
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$826.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$843.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$843.73
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Medicare |
$717.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,012.48
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
BIOPSY CERVX SINGL/MULT/EXCIS OF LES SPX
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
6157500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$1,687.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$687.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$687.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$544.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$843.73
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: GEHA Medicare |
$843.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Humana ChoiceCare |
$928.10
|
| Rate for Payer: Humana Medicare Advantage |
$843.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,417.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$555.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$843.73
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,434.34
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$641.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$555.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$843.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,687.46
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$826.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$843.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$843.73
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Medicare |
$717.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,012.48
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
BIOPSY CERVX SINGL/MULT/EXCIS OF LES SPX
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
23500018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
BIOPSY ELBOW JOINT LINING
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
CPT 24100
|
| Hospital Charge Code |
6124100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$806.55 |
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$721.65
|
| Rate for Payer: First Health Commercial |
$764.10
|
| Rate for Payer: First Health Workers Compensation |
$327.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.10
|
| Rate for Payer: GEHA Commercial |
$594.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.10
|
| Rate for Payer: Multiplan All |
$772.59
|
| Rate for Payer: OMNI Networks Commercial |
$594.30
|
| Rate for Payer: One Health Plan PPO/POS |
$764.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$806.55
|
| Rate for Payer: Three Rivers Provider Network All |
$636.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$789.57
|
| Rate for Payer: Zelis Auto |
$339.60
|
| Rate for Payer: Zelis Worker's Compensation |
$231.78
|
|
|
BIOPSY ELBOW JOINT LINING
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
CPT 24100
|
| Hospital Charge Code |
6124100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$509.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$721.65
|
| Rate for Payer: First Health Commercial |
$764.10
|
| Rate for Payer: First Health Workers Compensation |
$327.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.10
|
| Rate for Payer: GEHA Commercial |
$679.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.10
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$772.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$594.30
|
| Rate for Payer: One Health Plan PPO/POS |
$764.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$806.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$636.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$789.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$339.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$231.78
|
|
|
BIOPSY EXTERNAL AUDITOR CANAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 69105
|
| Hospital Charge Code |
6169109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$2,870.66 |
| 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 |
$117.60
|
| 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 |
$1,435.33
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: GEHA Medicare |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$1,578.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,411.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| 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 |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Medicare |
$1,220.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
BIOPSY EXTERNAL AUDITOR CANAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 69105
|
| Hospital Charge Code |
6169109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
6169100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$258.63
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
8511102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.61 |
| Max. Negotiated Rate |
$450.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$225.02
|
| Rate for Payer: Cash Price |
$155.18
|
| Rate for Payer: Cash Price |
$155.18
|
| Rate for Payer: Cigna Commercial |
$219.84
|
| Rate for Payer: First Health Commercial |
$232.77
|
| Rate for Payer: First Health Workers Compensation |
$99.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.77
|
| Rate for Payer: GEHA Commercial |
$206.90
|
| Rate for Payer: GEHA Medicare |
$225.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.77
|
| Rate for Payer: Humana ChoiceCare |
$247.52
|
| Rate for Payer: Humana Medicare Advantage |
$225.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$378.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$225.02
|
| Rate for Payer: Multiplan All |
$235.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$382.53
|
| Rate for Payer: OMNI Networks Commercial |
$181.04
|
| Rate for Payer: One Health Plan PPO/POS |
$232.77
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$225.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$450.04
|
| Rate for Payer: Three Rivers Provider Network All |
$193.97
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$225.02
|
| Rate for Payer: Zelis Auto |
$103.45
|
| Rate for Payer: Zelis Medicare |
$191.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.02
|
| Rate for Payer: Zelis Worker's Compensation |
$70.61
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$258.63
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
7269100
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.61 |
| Max. Negotiated Rate |
$450.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$225.02
|
| Rate for Payer: Cash Price |
$155.18
|
| Rate for Payer: Cash Price |
$155.18
|
| Rate for Payer: Cigna Commercial |
$219.84
|
| Rate for Payer: First Health Commercial |
$232.77
|
| Rate for Payer: First Health Workers Compensation |
$99.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.77
|
| Rate for Payer: GEHA Commercial |
$206.90
|
| Rate for Payer: GEHA Medicare |
$225.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.77
|
| Rate for Payer: Humana ChoiceCare |
$247.52
|
| Rate for Payer: Humana Medicare Advantage |
$225.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$378.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$225.02
|
| Rate for Payer: Multiplan All |
$235.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$382.53
|
| Rate for Payer: OMNI Networks Commercial |
$181.04
|
| Rate for Payer: One Health Plan PPO/POS |
$232.77
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$225.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$450.04
|
| Rate for Payer: Three Rivers Provider Network All |
$193.97
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$225.02
|
| Rate for Payer: Zelis Auto |
$103.45
|
| Rate for Payer: Zelis Medicare |
$191.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.02
|
| Rate for Payer: Zelis Worker's Compensation |
$70.61
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
21669100
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$375.10 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$530.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$961.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Worker's Compensation |
$375.10
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
21669100
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$824.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$225.02
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$530.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$1,099.20
|
| Rate for Payer: GEHA Medicare |
$225.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Humana ChoiceCare |
$247.52
|
| Rate for Payer: Humana Medicare Advantage |
$225.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$378.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$225.02
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$382.53
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$225.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$450.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$225.02
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Medicare |
$191.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.02
|
| Rate for Payer: Zelis Worker's Compensation |
$375.10
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$258.63
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
8511102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.61 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Cash Price |
$155.18
|
| Rate for Payer: Cigna Commercial |
$219.84
|
| Rate for Payer: First Health Commercial |
$232.77
|
| Rate for Payer: First Health Workers Compensation |
$99.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.77
|
| Rate for Payer: GEHA Commercial |
$181.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.77
|
| Rate for Payer: Multiplan All |
$235.35
|
| Rate for Payer: OMNI Networks Commercial |
$181.04
|
| Rate for Payer: One Health Plan PPO/POS |
$232.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.70
|
| Rate for Payer: Three Rivers Provider Network All |
$193.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.53
|
| Rate for Payer: Zelis Auto |
$103.45
|
| Rate for Payer: Zelis Worker's Compensation |
$70.61
|
|
