|
BIOPSY MUSCLE PERCUTANEOUS NEEDLE
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
8300020
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: First Health Commercial |
$621.00
|
| Rate for Payer: First Health Workers Compensation |
$266.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.00
|
| Rate for Payer: GEHA Commercial |
$483.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.00
|
| Rate for Payer: Multiplan All |
$627.90
|
| Rate for Payer: OMNI Networks Commercial |
$483.00
|
| Rate for Payer: One Health Plan PPO/POS |
$621.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.50
|
| Rate for Payer: Three Rivers Provider Network All |
$517.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.70
|
| Rate for Payer: Zelis Auto |
$276.00
|
| Rate for Payer: Zelis Worker's Compensation |
$188.37
|
|
|
BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Facility
|
OP
|
$1,532.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
1900021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.43 |
| Max. Negotiated Rate |
$1,455.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$919.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: First Health Commercial |
$1,378.80
|
| Rate for Payer: First Health Workers Compensation |
$591.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,378.80
|
| Rate for Payer: GEHA Commercial |
$1,225.60
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,378.80
|
| 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 |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$1,394.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,072.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,378.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,455.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,424.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$612.80
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$418.24
|
|
|
BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
6111755
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$156.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| 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 |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Facility
|
IP
|
$1,532.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
1900021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.24 |
| Max. Negotiated Rate |
$1,455.40 |
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: First Health Commercial |
$1,378.80
|
| Rate for Payer: First Health Workers Compensation |
$591.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,378.80
|
| Rate for Payer: GEHA Commercial |
$1,072.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,378.80
|
| Rate for Payer: Multiplan All |
$1,394.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,072.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,378.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,455.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,424.76
|
| Rate for Payer: Zelis Auto |
$612.80
|
| Rate for Payer: Zelis Worker's Compensation |
$418.24
|
|
|
BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
20300021
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$140.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$254.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Worker's Compensation |
$99.37
|
|
|
BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
20300021
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$140.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| 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 |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$99.37
|
|
|
BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
6111755
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$136.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
BIOPSY OF BOWEL
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 44100
|
| Hospital Charge Code |
6144100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$239.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
BIOPSY OF BOWEL
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 44100
|
| Hospital Charge Code |
6144100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$273.60
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
BIOPSY OF EPIDIDYMIS
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 54800
|
| Hospital Charge Code |
6154800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.11 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$237.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$336.60
|
| Rate for Payer: First Health Commercial |
$356.40
|
| Rate for Payer: First Health Workers Compensation |
$152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$356.40
|
| Rate for Payer: GEHA Commercial |
$316.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$356.40
|
| 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 |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$360.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$277.20
|
| Rate for Payer: One Health Plan PPO/POS |
$356.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$376.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$297.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$368.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$158.40
|
| 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 |
$108.11
|
|
|
BIOPSY OF EPIDIDYMIS
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 54800
|
| Hospital Charge Code |
6154800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.11 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$336.60
|
| Rate for Payer: First Health Commercial |
$356.40
|
| Rate for Payer: First Health Workers Compensation |
$152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$356.40
|
| Rate for Payer: GEHA Commercial |
$277.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$356.40
|
| Rate for Payer: Multiplan All |
$360.36
|
| Rate for Payer: OMNI Networks Commercial |
$277.20
|
| Rate for Payer: One Health Plan PPO/POS |
$356.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$376.20
|
| Rate for Payer: Three Rivers Provider Network All |
$297.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$368.28
|
| Rate for Payer: Zelis Auto |
$158.40
|
| Rate for Payer: Zelis Worker's Compensation |
$108.11
|
|
|
BIOPSY OF FLOOR OF MOUTH
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 41108
|
| Hospital Charge Code |
6141108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$224.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| 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 |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$112.40
|
| 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 |
$76.71
|
|
|
BIOPSY OF FLOOR OF MOUTH
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 41108
|
| Hospital Charge Code |
6141108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$196.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
BIOPSY OF FOOT JOINT LINING
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 28050
|
| Hospital Charge Code |
6128050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$568.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
BIOPSY OF FOOT JOINT LINING
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 28050
|
| Hospital Charge Code |
6128050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$497.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
BIOPSY OF FOOT JOINT LINING
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 28052
|
| Hospital Charge Code |
6128052
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$436.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$280.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$581.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$198.47
|
|
|
BIOPSY OF FOOT JOINT LINING
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 28052
|
| Hospital Charge Code |
6128052
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$280.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$508.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.11
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Worker's Compensation |
$198.47
|
|
|
BIOPSY OF HIP JOINT
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
6127052
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cigna Commercial |
$999.60
|
| Rate for Payer: First Health Commercial |
$1,058.40
|
| Rate for Payer: First Health Workers Compensation |
$454.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,058.40
|
| Rate for Payer: GEHA Commercial |
$823.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,058.40
|
| Rate for Payer: Multiplan All |
$1,070.16
|
| Rate for Payer: OMNI Networks Commercial |
$823.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,058.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,117.20
|
| Rate for Payer: Three Rivers Provider Network All |
$882.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,093.68
|
| Rate for Payer: Zelis Auto |
$470.40
|
| Rate for Payer: Zelis Worker's Compensation |
$321.05
|
|
|
BIOPSY OF HIP JOINT
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
6127052
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$705.60
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cigna Commercial |
$999.60
|
| Rate for Payer: First Health Commercial |
$1,058.40
|
| Rate for Payer: First Health Workers Compensation |
$454.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,058.40
|
| Rate for Payer: GEHA Commercial |
$940.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,058.40
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,070.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$823.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,058.40
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,117.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$882.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,093.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$470.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$321.05
|
|
|
BIOPSY OF LIP
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
6140490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
BIOPSY OF LIP
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
6140490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$441.00 |
| 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 |
$136.80
|
| 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 |
$220.50
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| 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 |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
BIOPSY OF MOUTH LESION
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
6140808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.91 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$283.05
|
| Rate for Payer: First Health Commercial |
$299.70
|
| Rate for Payer: First Health Workers Compensation |
$128.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$299.70
|
| Rate for Payer: GEHA Commercial |
$233.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$299.70
|
| Rate for Payer: Multiplan All |
$303.03
|
| Rate for Payer: OMNI Networks Commercial |
$233.10
|
| Rate for Payer: One Health Plan PPO/POS |
$299.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$316.35
|
| Rate for Payer: Three Rivers Provider Network All |
$249.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$309.69
|
| Rate for Payer: Zelis Auto |
$133.20
|
| Rate for Payer: Zelis Worker's Compensation |
$90.91
|
|
|
BIOPSY OF MOUTH LESION
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
6140808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.91 |
| Max. Negotiated Rate |
$967.10 |
| 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 |
$199.80
|
| 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 |
$483.55
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$283.05
|
| Rate for Payer: First Health Commercial |
$299.70
|
| Rate for Payer: First Health Workers Compensation |
$128.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$299.70
|
| Rate for Payer: GEHA Commercial |
$266.40
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$299.70
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$303.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$233.10
|
| Rate for Payer: One Health Plan PPO/POS |
$299.70
|
| 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 |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$316.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$249.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$309.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$133.20
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$90.91
|
|
|
BIOPSY OF NECK/CHEST
|
Facility
|
IP
|
$726.12
|
|
|
Service Code
|
CPT 21550
|
| Hospital Charge Code |
8521550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$689.81 |
| Rate for Payer: Cash Price |
$435.67
|
| Rate for Payer: Cigna Commercial |
$617.20
|
| Rate for Payer: First Health Commercial |
$653.51
|
| Rate for Payer: First Health Workers Compensation |
$280.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$653.51
|
| Rate for Payer: GEHA Commercial |
$508.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$653.51
|
| Rate for Payer: Multiplan All |
$660.77
|
| Rate for Payer: OMNI Networks Commercial |
$508.28
|
| Rate for Payer: One Health Plan PPO/POS |
$653.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$689.81
|
| Rate for Payer: Three Rivers Provider Network All |
$544.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$675.29
|
| Rate for Payer: Zelis Auto |
$290.45
|
| Rate for Payer: Zelis Worker's Compensation |
$198.23
|
|
|
BIOPSY OF NECK/CHEST
|
Facility
|
OP
|
$726.12
|
|
|
Service Code
|
CPT 21550
|
| Hospital Charge Code |
7221550
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$435.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$435.67
|
| Rate for Payer: Cash Price |
$435.67
|
| Rate for Payer: Cigna Commercial |
$617.20
|
| Rate for Payer: First Health Commercial |
$653.51
|
| Rate for Payer: First Health Workers Compensation |
$280.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$653.51
|
| Rate for Payer: GEHA Commercial |
$580.90
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$653.51
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$660.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$508.28
|
| Rate for Payer: One Health Plan PPO/POS |
$653.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$689.81
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$544.59
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$675.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$290.45
|
| 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 |
$198.23
|
|
