|
DRAINAGE OF PROSTATE ABSCESS
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT 52700
|
| Hospital Charge Code |
6152700
|
|
Hospital Revenue Code
|
975
|
| 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 PROSTATE ABSCESS
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 55725
|
| Hospital Charge Code |
6155725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.51 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$470.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$974.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
DRAINAGE OF PROSTATE ABSCESS
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 55725
|
| Hospital Charge Code |
6155725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.51 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$470.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$852.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
DRAINAGE OF PROSTATE ABSCESS
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
CPT 55720
|
| Hospital Charge Code |
6155720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.16 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$791.35
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: First Health Workers Compensation |
$359.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.90
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.90
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$847.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$651.70
|
| Rate for Payer: One Health Plan PPO/POS |
$837.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$884.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$698.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$865.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$372.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$254.16
|
|
|
DRAINAGE OF PROSTATE ABSCESS
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
CPT 55720
|
| Hospital Charge Code |
6155720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.16 |
| Max. Negotiated Rate |
$884.45 |
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$791.35
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: First Health Workers Compensation |
$359.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.90
|
| Rate for Payer: GEHA Commercial |
$651.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.90
|
| Rate for Payer: Multiplan All |
$847.21
|
| Rate for Payer: OMNI Networks Commercial |
$651.70
|
| Rate for Payer: One Health Plan PPO/POS |
$837.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$884.45
|
| Rate for Payer: Three Rivers Provider Network All |
$698.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$865.83
|
| Rate for Payer: Zelis Auto |
$372.40
|
| Rate for Payer: Zelis Worker's Compensation |
$254.16
|
|
|
DRAINAGE OF PROSTATE ABSCESS
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT 52700
|
| Hospital Charge Code |
6152700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.79 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| 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 |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| 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 |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$813.60
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$822.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| 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 |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$858.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$678.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$840.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$361.60
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$246.79
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
6145020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.05 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$712.20
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$1,008.95
|
| Rate for Payer: First Health Commercial |
$1,068.30
|
| Rate for Payer: First Health Workers Compensation |
$458.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,068.30
|
| Rate for Payer: GEHA Commercial |
$949.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,068.30
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,080.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$830.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,068.30
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,127.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$890.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,103.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$474.80
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$324.05
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
6145005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.41 |
| Max. Negotiated Rate |
$2,239.16 |
| 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 |
$297.60
|
| 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 |
$1,119.58
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$421.60
|
| Rate for Payer: First Health Commercial |
$446.40
|
| Rate for Payer: First Health Workers Compensation |
$191.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$446.40
|
| Rate for Payer: GEHA Commercial |
$396.80
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$446.40
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$451.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$347.20
|
| Rate for Payer: One Health Plan PPO/POS |
$446.40
|
| 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 |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$471.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$372.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$461.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$198.40
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$135.41
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
6145020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.05 |
| Max. Negotiated Rate |
$1,127.65 |
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$1,008.95
|
| Rate for Payer: First Health Commercial |
$1,068.30
|
| Rate for Payer: First Health Workers Compensation |
$458.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,068.30
|
| Rate for Payer: GEHA Commercial |
$830.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,068.30
|
| Rate for Payer: Multiplan All |
$1,080.17
|
| Rate for Payer: OMNI Networks Commercial |
$830.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,068.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,127.65
|
| Rate for Payer: Three Rivers Provider Network All |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,103.91
|
| Rate for Payer: Zelis Auto |
$474.80
|
| Rate for Payer: Zelis Worker's Compensation |
$324.05
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
6145005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.41 |
| Max. Negotiated Rate |
$471.20 |
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$421.60
|
| Rate for Payer: First Health Commercial |
$446.40
|
| Rate for Payer: First Health Workers Compensation |
$191.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$446.40
|
| Rate for Payer: GEHA Commercial |
$347.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$446.40
|
| Rate for Payer: Multiplan All |
$451.36
|
| Rate for Payer: OMNI Networks Commercial |
$347.20
|
| Rate for Payer: One Health Plan PPO/POS |
$446.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$471.20
|
| Rate for Payer: Three Rivers Provider Network All |
$372.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$461.28
|
| Rate for Payer: Zelis Auto |
$198.40
|
| Rate for Payer: Zelis Worker's Compensation |
$135.41
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 42300
|
| Hospital Charge Code |
6142300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$378.40
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$439.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
6142320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$210.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$435.20
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$148.51
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
6142320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$210.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$380.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Worker's Compensation |
$148.51
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
CPT 42305
|
| Hospital Charge Code |
6142305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$244.06 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$536.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna Commercial |
$759.90
|
| Rate for Payer: First Health Commercial |
$804.60
|
| Rate for Payer: First Health Workers Compensation |
$345.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$804.60
|
| Rate for Payer: GEHA Commercial |
$715.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$804.60
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$813.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$625.80
|
| Rate for Payer: One Health Plan PPO/POS |
$804.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$849.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$670.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$831.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$357.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$244.06
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 42305
|
| Hospital Charge Code |
6142305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$244.06 |
| Max. Negotiated Rate |
$849.30 |
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna Commercial |
$759.90
|
| Rate for Payer: First Health Commercial |
$804.60
|
| Rate for Payer: First Health Workers Compensation |
$345.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$804.60
|
| Rate for Payer: GEHA Commercial |
$625.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$804.60
|
| Rate for Payer: Multiplan All |
$813.54
|
| Rate for Payer: OMNI Networks Commercial |
$625.80
|
| Rate for Payer: One Health Plan PPO/POS |
$804.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$849.30
|
| Rate for Payer: Three Rivers Provider Network All |
$670.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$831.42
|
| Rate for Payer: Zelis Auto |
$357.60
|
| Rate for Payer: Zelis Worker's Compensation |
$244.06
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 42300
|
| Hospital Charge Code |
6142300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$331.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$439.89
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
DRAINAGE OF SCROTUM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
6154700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$385.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Worker's Compensation |
$150.15
|
|
|
DRAINAGE OF SCROTUM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
6154700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$440.00
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$150.15
|
|
|
DRAINAGE OF SCROTUM ABSCESS
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
6155100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$306.00
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: First Health Workers Compensation |
$196.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$408.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$139.23
|
|
|
DRAINAGE OF SCROTUM ABSCESS
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
6155100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: First Health Workers Compensation |
$196.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$357.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$139.23
|
|
|
DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 26020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,365.04 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 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 |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
CPT 42725
|
| Hospital Charge Code |
6142725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.55 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,018.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$1,443.30
|
| Rate for Payer: First Health Commercial |
$1,528.20
|
| Rate for Payer: First Health Workers Compensation |
$655.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,528.20
|
| Rate for Payer: GEHA Commercial |
$1,358.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,528.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,545.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,188.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,528.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,613.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,273.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,579.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$679.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$463.55
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
CPT 42725
|
| Hospital Charge Code |
6142725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.55 |
| Max. Negotiated Rate |
$1,613.10 |
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$1,443.30
|
| Rate for Payer: First Health Commercial |
$1,528.20
|
| Rate for Payer: First Health Workers Compensation |
$655.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,528.20
|
| Rate for Payer: GEHA Commercial |
$1,188.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,528.20
|
| Rate for Payer: Multiplan All |
$1,545.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,188.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,528.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,613.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,579.14
|
| Rate for Payer: Zelis Auto |
$679.20
|
| Rate for Payer: Zelis Worker's Compensation |
$463.55
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
6142720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.04 |
| Max. Negotiated Rate |
$776.15 |
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$694.45
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: First Health Workers Compensation |
$315.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$735.30
|
| Rate for Payer: GEHA Commercial |
$571.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$735.30
|
| Rate for Payer: Multiplan All |
$743.47
|
| Rate for Payer: OMNI Networks Commercial |
$571.90
|
| Rate for Payer: One Health Plan PPO/POS |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$776.15
|
| Rate for Payer: Three Rivers Provider Network All |
$612.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$759.81
|
| Rate for Payer: Zelis Auto |
$326.80
|
| Rate for Payer: Zelis Worker's Compensation |
$223.04
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
6142720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.04 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$490.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$694.45
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: First Health Workers Compensation |
$315.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$735.30
|
| Rate for Payer: GEHA Commercial |
$653.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$735.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$743.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$571.90
|
| Rate for Payer: One Health Plan PPO/POS |
$735.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$776.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$612.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$759.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$326.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$223.04
|
|
