|
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 |
$6,683.96 |
| 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 |
$3,341.98
|
| 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 |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
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
|
$931.00
|
|
|
Service Code
|
CPT 55720
|
| Hospital Charge Code |
6155720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.16 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$3,341.98
|
| 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 |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.90
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$847.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$884.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$698.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$865.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$372.40
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$254.16
|
|
|
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
|
$904.00
|
|
|
Service Code
|
CPT 52700
|
| Hospital Charge Code |
6152700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.79 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$3,341.98
|
| 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 |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$813.60
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$822.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$858.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$678.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$840.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$361.60
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$246.79
|
|
|
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 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 |
$2,285.00 |
| 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 |
$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 |
$1,142.50
|
| 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 |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$446.40
|
| 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 |
$451.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| 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 |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$471.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$372.00
|
| 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 |
$461.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$198.40
|
| 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 |
$135.41
|
|
|
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 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 |
$5,314.64 |
| 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 |
$2,657.32
|
| 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 |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,068.30
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,080.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| 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 |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,127.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$890.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,103.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$474.80
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$324.05
|
|
|
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 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 |
$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 |
$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 |
$493.45
|
| 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 |
$493.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| 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 |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$838.87
|
| 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 |
$493.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$986.90
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| 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 |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$493.45
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Medicare |
$419.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$592.14
|
| Rate for Payer: Zelis Worker's Compensation |
$148.51
|
|
|
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 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 |
$6,284.94 |
| 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 |
$3,142.47
|
| 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 |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$804.60
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$813.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$849.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$670.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$831.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$357.60
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$244.06
|
|
|
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 |
$2,870.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$1,435.33
|
| 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 |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Humana ChoiceCare |
$1,578.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,411.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| 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 |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$439.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Medicare |
$1,220.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
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 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 |
$3,969.94 |
| 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 |
$1,984.97
|
| 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 |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| 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 |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| 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 |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$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
|
$6,287.92
|
|
|
Service Code
|
CPT 26020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,365.04 |
| 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 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: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| 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: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 Worker's Compensation |
$6,287.92
|
| 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: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| 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 |
$2,861.00
|
|
|
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 |
$11,464.32 |
| 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 |
$5,732.16
|
| 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 |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,528.20
|
| 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 |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,545.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,613.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,273.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,579.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$679.20
|
| 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 |
$463.55
|
|
|
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 |
$6,284.94 |
| 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 |
$3,142.47
|
| 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 |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$735.30
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$743.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$776.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$612.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$759.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$326.80
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$223.04
|
|
|
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
|
|
