|
DRAINAGE OF BONE LESION
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 21510
|
| Hospital Charge Code |
6121510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.20
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$741.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Humana ChoiceCare |
$241.02
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$556.20
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$815.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$231.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$463.50
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
DRAINAGE OF BURSA OF FOOT
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 28001
|
| Hospital Charge Code |
6128001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$363.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
DRAINAGE OF BURSA OF FOOT
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 28001
|
| Hospital Charge Code |
6128001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$415.20
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| 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 |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$207.60
|
| 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 |
$141.69
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
6167700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$242.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
6167700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$579.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$258.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$289.66
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$276.80
|
| Rate for Payer: GEHA Medicare |
$289.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Humana ChoiceCare |
$318.63
|
| Rate for Payer: Humana Medicare Advantage |
$289.66
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$486.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$263.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$289.66
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$492.42
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$304.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$263.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$289.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$579.32
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$289.66
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Medicare |
$246.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$347.59
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
6126010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$112.75
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
6126011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$153.15 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna Commercial |
$476.85
|
| Rate for Payer: First Health Commercial |
$504.90
|
| Rate for Payer: First Health Workers Compensation |
$216.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.90
|
| Rate for Payer: GEHA Commercial |
$448.80
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.90
|
| 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 |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$510.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$392.70
|
| Rate for Payer: One Health Plan PPO/POS |
$504.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$420.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$521.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$224.40
|
| 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 |
$153.15
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
6126010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$289.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Worker's Compensation |
$112.75
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
6126011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$153.15 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna Commercial |
$476.85
|
| Rate for Payer: First Health Commercial |
$504.90
|
| Rate for Payer: First Health Workers Compensation |
$216.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.90
|
| Rate for Payer: GEHA Commercial |
$392.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.90
|
| Rate for Payer: Multiplan All |
$510.51
|
| Rate for Payer: OMNI Networks Commercial |
$392.70
|
| Rate for Payer: One Health Plan PPO/POS |
$504.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.95
|
| Rate for Payer: Three Rivers Provider Network All |
$420.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$521.73
|
| Rate for Payer: Zelis Auto |
$224.40
|
| Rate for Payer: Zelis Worker's Compensation |
$153.15
|
|
|
DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
|
Facility
|
OP
|
$3,139.96
|
|
|
Service Code
|
CPT 26011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,010.98 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| 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 |
$1,031.57
|
| 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 |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| 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 |
$1,031.57
|
| 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
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
12041967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$162.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$114.66
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
19026010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$162.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$294.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.66
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
19026010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$162.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$114.66
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
20326010
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$858.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$542.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cigna Commercial |
$768.40
|
| Rate for Payer: First Health Commercial |
$813.60
|
| Rate for Payer: First Health Workers Compensation |
$349.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$813.60
|
| Rate for Payer: GEHA Commercial |
$723.20
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$813.60
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$822.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$632.80
|
| Rate for Payer: One Health Plan PPO/POS |
$813.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$858.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$678.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$840.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$361.60
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$246.79
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
12041967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$162.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$294.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.66
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
20326010
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$246.79 |
| Max. Negotiated Rate |
$858.80 |
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cigna Commercial |
$768.40
|
| Rate for Payer: First Health Commercial |
$813.60
|
| Rate for Payer: First Health Workers Compensation |
$349.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$813.60
|
| Rate for Payer: GEHA Commercial |
$632.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$813.60
|
| Rate for Payer: Multiplan All |
$822.64
|
| Rate for Payer: OMNI Networks Commercial |
$632.80
|
| Rate for Payer: One Health Plan PPO/POS |
$813.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$858.80
|
| Rate for Payer: Three Rivers Provider Network All |
$678.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$840.72
|
| Rate for Payer: Zelis Auto |
$361.60
|
| Rate for Payer: Zelis Worker's Compensation |
$246.79
|
|
|
DRAINAGE OF FOREARM BURSA
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 25031
|
| Hospital Charge Code |
6125031
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Worker's Compensation |
$247.61
|
|
|
DRAINAGE OF FOREARM BURSA
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 25031
|
| Hospital Charge Code |
6125031
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$544.20
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$247.61
|
|
|
DRAINAGE OF FOREARM LESION
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
6125028
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.65 |
| 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 |
$630.00
|
| 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 |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: First Health Workers Compensation |
$405.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$840.00
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| 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 |
$955.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| 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 |
$997.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| 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 |
$976.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$420.00
|
| 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 |
$286.65
|
|
|
DRAINAGE OF FOREARM LESION
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
6125028
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: First Health Workers Compensation |
$405.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$735.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
| Rate for Payer: Zelis Worker's Compensation |
$286.65
|
|
|
DRAINAGE OF HIP JOINT
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 27030
|
| Hospital Charge Code |
6127030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$526.07 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$1,637.95
|
| Rate for Payer: First Health Commercial |
$1,734.30
|
| Rate for Payer: First Health Workers Compensation |
$744.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,734.30
|
| Rate for Payer: GEHA Commercial |
$1,348.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,734.30
|
| Rate for Payer: Multiplan All |
$1,753.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,348.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,734.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,830.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,445.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,792.11
|
| Rate for Payer: Zelis Auto |
$770.80
|
| Rate for Payer: Zelis Worker's Compensation |
$526.07
|
|
|
DRAINAGE OF HIP JOINT
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 27030
|
| Hospital Charge Code |
6127030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$481.75 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$1,637.95
|
| Rate for Payer: First Health Commercial |
$1,734.30
|
| Rate for Payer: First Health Workers Compensation |
$744.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,734.30
|
| Rate for Payer: GEHA Commercial |
$1,541.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,734.30
|
| Rate for Payer: Humana ChoiceCare |
$501.02
|
| Rate for Payer: Multiplan All |
$1,753.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,156.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,348.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,734.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,830.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,445.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,695.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$481.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,792.11
|
| Rate for Payer: Zelis Auto |
$770.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$963.50
|
| Rate for Payer: Zelis Worker's Compensation |
$526.07
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
6155000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$1,363.52 |
| 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 |
$157.80
|
| 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 |
$681.76
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: GEHA Medicare |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| 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 |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| Rate for Payer: Zelis Worker's Compensation |
$71.80
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
6155000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Worker's Compensation |
$71.80
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6140800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
