|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6140800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$1,363.52 |
| 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 |
$242.40
|
| 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 |
$681.76
|
| Rate for Payer: Cash Price |
$242.40
|
| 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 |
$323.20
|
| Rate for Payer: GEHA Medicare |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| 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 |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| 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 |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 41005
|
| Hospital Charge Code |
6141005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.11 |
| 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 |
$231.00
|
| 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 |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$308.00
|
| Rate for Payer: GEHA Medicare |
$225.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| 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 |
$350.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$382.53
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| 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 |
$365.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$450.04
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| 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 |
$358.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$225.02
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Medicare |
$191.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.02
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 41016
|
| Hospital Charge Code |
6141016
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$11,464.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$546.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,732.16
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$728.80
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 41016
|
| Hospital Charge Code |
6141016
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
CPT 40801
|
| Hospital Charge Code |
6140801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$986.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$345.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$493.45
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$489.60
|
| Rate for Payer: First Health Commercial |
$518.40
|
| Rate for Payer: First Health Workers Compensation |
$222.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$518.40
|
| Rate for Payer: GEHA Commercial |
$460.80
|
| Rate for Payer: GEHA Medicare |
$493.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$518.40
|
| Rate for Payer: Humana ChoiceCare |
$542.79
|
| Rate for Payer: Humana Medicare Advantage |
$493.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$829.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$493.45
|
| Rate for Payer: Multiplan All |
$524.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$838.87
|
| Rate for Payer: OMNI Networks Commercial |
$403.20
|
| Rate for Payer: One Health Plan PPO/POS |
$518.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$493.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$547.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$986.90
|
| Rate for Payer: Three Rivers Provider Network All |
$432.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$483.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$535.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$493.45
|
| Rate for Payer: Zelis Auto |
$230.40
|
| Rate for Payer: Zelis Medicare |
$419.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$592.14
|
| Rate for Payer: Zelis Worker's Compensation |
$157.25
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
CPT 40801
|
| Hospital Charge Code |
6140801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$489.60
|
| Rate for Payer: First Health Commercial |
$518.40
|
| Rate for Payer: First Health Workers Compensation |
$222.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$518.40
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$518.40
|
| Rate for Payer: Multiplan All |
$524.16
|
| Rate for Payer: OMNI Networks Commercial |
$403.20
|
| Rate for Payer: One Health Plan PPO/POS |
$518.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$547.20
|
| Rate for Payer: Three Rivers Provider Network All |
$432.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$535.68
|
| Rate for Payer: Zelis Auto |
$230.40
|
| Rate for Payer: Zelis Worker's Compensation |
$157.25
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 41005
|
| Hospital Charge Code |
6141005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DRAINAGE OF NOSE LESION
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
6130020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$576.30
|
| Rate for Payer: First Health Commercial |
$610.20
|
| Rate for Payer: First Health Workers Compensation |
$261.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$610.20
|
| Rate for Payer: GEHA Commercial |
$474.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$610.20
|
| Rate for Payer: Multiplan All |
$616.98
|
| Rate for Payer: OMNI Networks Commercial |
$474.60
|
| Rate for Payer: One Health Plan PPO/POS |
$610.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$644.10
|
| Rate for Payer: Three Rivers Provider Network All |
$508.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$630.54
|
| Rate for Payer: Zelis Auto |
$271.20
|
| Rate for Payer: Zelis Worker's Compensation |
$185.09
|
|
|
DRAINAGE OF NOSE LESION
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
6130020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$986.90 |
| 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 |
$406.80
|
| 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 |
$493.45
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$576.30
|
| Rate for Payer: First Health Commercial |
$610.20
|
| Rate for Payer: First Health Workers Compensation |
$261.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$610.20
|
| Rate for Payer: GEHA Commercial |
$542.40
|
| Rate for Payer: GEHA Medicare |
$493.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$610.20
|
| Rate for Payer: Humana ChoiceCare |
$542.79
|
| Rate for Payer: Humana Medicare Advantage |
$493.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$829.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$493.45
|
| Rate for Payer: Multiplan All |
$616.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$838.87
|
| Rate for Payer: OMNI Networks Commercial |
$474.60
|
| Rate for Payer: One Health Plan PPO/POS |
$610.20
|
| 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 |
$493.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$644.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$986.90
|
| Rate for Payer: Three Rivers Provider Network All |
$508.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$483.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$630.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$493.45
|
| Rate for Payer: Zelis Auto |
$271.20
|
| Rate for Payer: Zelis Medicare |
$419.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$592.14
|
| Rate for Payer: Zelis Worker's Compensation |
$185.09
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 58800
|
| Hospital Charge Code |
6158800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$637.50
|
| Rate for Payer: First Health Commercial |
$675.00
|
| Rate for Payer: First Health Workers Compensation |
$289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.00
|
| Rate for Payer: GEHA Commercial |
$525.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.00
|
| Rate for Payer: Multiplan All |
$682.50
|
| Rate for Payer: OMNI Networks Commercial |
$525.00
|
| Rate for Payer: One Health Plan PPO/POS |
$675.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$712.50
|
| Rate for Payer: Three Rivers Provider Network All |
$562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$697.50
|
| Rate for Payer: Zelis Auto |
$300.00
|
| Rate for Payer: Zelis Worker's Compensation |
$204.75
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 58800
|
| Hospital Charge Code |
6158800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$6,161.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.90
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$637.50
|
| Rate for Payer: First Health Commercial |
$675.00
|
| Rate for Payer: First Health Workers Compensation |
$289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.00
|
| Rate for Payer: GEHA Commercial |
$600.00
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: Multiplan All |
$682.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| Rate for Payer: OMNI Networks Commercial |
$525.00
|
| Rate for Payer: One Health Plan PPO/POS |
$675.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$712.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: Three Rivers Provider Network All |
$562.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$697.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Auto |
$300.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$204.75
|
|
|
DRAINAGE OF PALM BURSA
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 26025
|
| Hospital Charge Code |
6126025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.41 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$726.75
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: First Health Workers Compensation |
$330.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.50
|
| Rate for Payer: GEHA Commercial |
$598.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.50
|
| Rate for Payer: Multiplan All |
$778.05
|
| Rate for Payer: OMNI Networks Commercial |
$598.50
|
| Rate for Payer: One Health Plan PPO/POS |
$769.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.25
|
| Rate for Payer: Three Rivers Provider Network All |
$641.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$795.15
|
| Rate for Payer: Zelis Auto |
$342.00
|
| Rate for Payer: Zelis Worker's Compensation |
$233.41
|
|
|
DRAINAGE OF PALM BURSA
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 26025
|
| Hospital Charge Code |
6126025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.41 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$726.75
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: First Health Workers Compensation |
$330.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.50
|
| Rate for Payer: GEHA Commercial |
$684.00
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.50
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$778.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$598.50
|
| Rate for Payer: One Health Plan PPO/POS |
$769.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$641.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$795.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$342.00
|
| 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 |
$233.41
|
|
|
DRAINAGE OF PALM BURSAS
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 26030
|
| Hospital Charge Code |
6126030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: First Health Workers Compensation |
$384.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Worker's Compensation |
$272.18
|
|
|
DRAINAGE OF PALM BURSAS
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT 26030
|
| Hospital Charge Code |
6126030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: First Health Workers Compensation |
$384.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$398.80
|
| 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 |
$272.18
|
|
|
DRAINAGE OF PELVIC ABSCESS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 45000
|
| Hospital Charge Code |
6145000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$612.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
DRAINAGE OF PELVIC ABSCESS
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 57010
|
| Hospital Charge Code |
6157010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$6,161.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.90
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
DRAINAGE OF PELVIC ABSCESS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 45000
|
| Hospital Charge Code |
6145000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$2,285.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,142.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$700.00
|
| Rate for Payer: GEHA Medicare |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Humana ChoiceCare |
$1,256.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,142.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,919.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,142.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Medicare |
$971.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
DRAINAGE OF PELVIC ABSCESS
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 57010
|
| Hospital Charge Code |
6157010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$613.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
DRAINAGE OF PELVIC FLUID
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 57020
|
| Hospital Charge Code |
6157020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
DRAINAGE OF PELVIC FLUID
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 57020
|
| Hospital Charge Code |
6157020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$9,566.64 |
| 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 |
$149.40
|
| 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 |
$4,783.32
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$4,783.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$5,261.65
|
| Rate for Payer: Humana Medicare Advantage |
$4,783.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,035.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$555.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,783.32
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,131.64
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| 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 |
$4,783.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,566.64
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,687.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,783.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,783.32
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$4,065.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,739.98
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
DRAINAGE OF PELVIS BURSA
|
Facility
|
IP
|
$1,066.00
|
|
|
Service Code
|
CPT 26991
|
| Hospital Charge Code |
6126991
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.02 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: First Health Workers Compensation |
$411.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$746.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| Rate for Payer: Multiplan All |
$970.06
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$991.38
|
| Rate for Payer: Zelis Auto |
$426.40
|
| Rate for Payer: Zelis Worker's Compensation |
$291.02
|
|
|
DRAINAGE OF PELVIS BURSA
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
CPT 26991
|
| Hospital Charge Code |
6126991
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.02 |
| 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 |
$639.60
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: First Health Workers Compensation |
$411.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$852.80
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| 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 |
$970.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| 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 |
$991.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$426.40
|
| 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 |
$291.02
|
|
|
DRAINAGE OF PELVIS LESION
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
6126990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.80 |
| 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 |
$764.40
|
| 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 |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$491.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$1,019.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| 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 |
$1,159.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| 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 |
$1,210.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| 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 |
$1,184.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$509.60
|
| 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 |
$347.80
|
|
|
DRAINAGE OF PELVIS LESION
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
6126990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.80 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$491.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$891.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| Rate for Payer: Multiplan All |
$1,159.34
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,210.30
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,184.82
|
| Rate for Payer: Zelis Auto |
$509.60
|
| Rate for Payer: Zelis Worker's Compensation |
$347.80
|
|
