|
DRAINAGE OF TONSIL ABSCESS
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
6142700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$161.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$113.84
|
|
|
DRAINAGE OF TONSIL ABSCESS
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
6142700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$161.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$113.84
|
|
|
DRAINAGE OF URETHRA ABSCESS
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
CPT 53040
|
| Hospital Charge Code |
6153040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$954.75 |
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$854.25
|
| Rate for Payer: First Health Commercial |
$904.50
|
| Rate for Payer: First Health Workers Compensation |
$388.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$904.50
|
| Rate for Payer: GEHA Commercial |
$703.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$904.50
|
| Rate for Payer: Multiplan All |
$914.55
|
| Rate for Payer: OMNI Networks Commercial |
$703.50
|
| Rate for Payer: One Health Plan PPO/POS |
$904.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$954.75
|
| Rate for Payer: Three Rivers Provider Network All |
$753.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$934.65
|
| Rate for Payer: Zelis Auto |
$402.00
|
| Rate for Payer: Zelis Worker's Compensation |
$274.37
|
|
|
DRAINAGE OF URETHRA ABSCESS
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
CPT 53040
|
| Hospital Charge Code |
6153040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$854.25
|
| Rate for Payer: First Health Commercial |
$904.50
|
| Rate for Payer: First Health Workers Compensation |
$388.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$904.50
|
| Rate for Payer: GEHA Commercial |
$804.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$904.50
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$914.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$703.50
|
| Rate for Payer: One Health Plan PPO/POS |
$904.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$954.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$753.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$934.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$402.00
|
| 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 |
$274.37
|
|
|
DRAINAGE OF URETHRA ABSCESS
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
6153060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
DRAINAGE OF URETHRA ABSCESS
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
6153060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$302.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$201.60
|
| 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 |
$137.59
|
|
|
DRAINAGE OF URINARY LEAKAGE
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 53085
|
| Hospital Charge Code |
6153085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$1,097.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$548.80
|
| 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 |
$374.56
|
|
|
DRAINAGE OF URINARY LEAKAGE
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 53080
|
| Hospital Charge Code |
6153080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.05 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna Commercial |
$731.85
|
| Rate for Payer: First Health Commercial |
$774.90
|
| Rate for Payer: First Health Workers Compensation |
$332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.90
|
| Rate for Payer: GEHA Commercial |
$602.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.90
|
| Rate for Payer: Multiplan All |
$783.51
|
| Rate for Payer: OMNI Networks Commercial |
$602.70
|
| Rate for Payer: One Health Plan PPO/POS |
$774.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.95
|
| Rate for Payer: Three Rivers Provider Network All |
$645.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$800.73
|
| Rate for Payer: Zelis Auto |
$344.40
|
| Rate for Payer: Zelis Worker's Compensation |
$235.05
|
|
|
DRAINAGE OF URINARY LEAKAGE
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 53085
|
| Hospital Charge Code |
6153085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$960.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
DRAINAGE OF URINARY LEAKAGE
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 53080
|
| Hospital Charge Code |
6153080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.05 |
| Max. Negotiated Rate |
$2,056.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$516.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna Commercial |
$731.85
|
| Rate for Payer: First Health Commercial |
$774.90
|
| Rate for Payer: First Health Workers Compensation |
$332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.90
|
| Rate for Payer: GEHA Commercial |
$688.80
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.90
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$783.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$602.70
|
| Rate for Payer: One Health Plan PPO/POS |
$774.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$645.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$800.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$344.40
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$235.05
|
|
|
DRAIN APP ABSCESS OPEN
|
Facility
|
OP
|
$1,621.00
|
|
|
Service Code
|
CPT 44900
|
| Hospital Charge Code |
6144900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$405.25 |
| Max. Negotiated Rate |
$1,539.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$972.60
|
| Rate for Payer: Cash Price |
$972.60
|
| Rate for Payer: Cigna Commercial |
$1,377.85
|
| Rate for Payer: First Health Commercial |
$1,458.90
|
| Rate for Payer: First Health Workers Compensation |
$625.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,458.90
|
| Rate for Payer: GEHA Commercial |
$1,296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,458.90
|
| Rate for Payer: Humana ChoiceCare |
$421.46
|
| Rate for Payer: Multiplan All |
$1,475.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$972.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,134.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,458.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,539.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,215.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,426.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$405.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,507.53
|
| Rate for Payer: Zelis Auto |
$648.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$810.50
|
| Rate for Payer: Zelis Worker's Compensation |
$442.53
|
|
|
DRAIN APP ABSCESS OPEN
|
Facility
|
IP
|
$1,621.00
|
|
|
Service Code
|
CPT 44900
|
| Hospital Charge Code |
6144900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$442.53 |
| Max. Negotiated Rate |
$1,539.95 |
| Rate for Payer: Cash Price |
$972.60
|
| Rate for Payer: Cigna Commercial |
$1,377.85
|
| Rate for Payer: First Health Commercial |
$1,458.90
|
| Rate for Payer: First Health Workers Compensation |
$625.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,458.90
|
| Rate for Payer: GEHA Commercial |
$1,134.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,458.90
|
| Rate for Payer: Multiplan All |
$1,475.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,134.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,458.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,539.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,215.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,507.53
|
| Rate for Payer: Zelis Auto |
$648.40
|
| Rate for Payer: Zelis Worker's Compensation |
$442.53
|
|
|
DRAIN ARM/ELBOW BONE LESION
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 23935
|
| Hospital Charge Code |
6123935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.92 |
| Max. Negotiated Rate |
$977.55 |
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cigna Commercial |
$874.65
|
| Rate for Payer: First Health Commercial |
$926.10
|
| Rate for Payer: First Health Workers Compensation |
$397.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$926.10
|
| Rate for Payer: GEHA Commercial |
$720.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$926.10
|
| Rate for Payer: Multiplan All |
$936.39
|
| Rate for Payer: OMNI Networks Commercial |
$720.30
|
| Rate for Payer: One Health Plan PPO/POS |
$926.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$977.55
|
| Rate for Payer: Three Rivers Provider Network All |
$771.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.97
|
| Rate for Payer: Zelis Auto |
$411.60
|
| Rate for Payer: Zelis Worker's Compensation |
$280.92
|
|
|
DRAIN ARM/ELBOW BONE LESION
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 23935
|
| Hospital Charge Code |
6123935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.92 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$617.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cigna Commercial |
$874.65
|
| Rate for Payer: First Health Commercial |
$926.10
|
| Rate for Payer: First Health Workers Compensation |
$397.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$926.10
|
| Rate for Payer: GEHA Commercial |
$823.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$926.10
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$936.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$720.30
|
| Rate for Payer: One Health Plan PPO/POS |
$926.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$977.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$771.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$411.60
|
| 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 |
$280.92
|
|
|
DRAIN BLADDER BY NEEDLE
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
6151100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$104.55
|
| Rate for Payer: First Health Commercial |
$110.70
|
| Rate for Payer: First Health Workers Compensation |
$47.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.70
|
| Rate for Payer: GEHA Commercial |
$98.40
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.70
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$111.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$86.10
|
| Rate for Payer: One Health Plan PPO/POS |
$110.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$92.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$49.20
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$33.58
|
|
|
DRAIN BLADDER BY NEEDLE
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
6151100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$104.55
|
| Rate for Payer: First Health Commercial |
$110.70
|
| Rate for Payer: First Health Workers Compensation |
$47.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.70
|
| Rate for Payer: GEHA Commercial |
$86.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.70
|
| Rate for Payer: Multiplan All |
$111.93
|
| Rate for Payer: OMNI Networks Commercial |
$86.10
|
| Rate for Payer: One Health Plan PPO/POS |
$110.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.85
|
| Rate for Payer: Three Rivers Provider Network All |
$92.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.39
|
| Rate for Payer: Zelis Auto |
$49.20
|
| Rate for Payer: Zelis Worker's Compensation |
$33.58
|
|
|
DRAIN BLADDER BY TROCAR/CATH
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 51101
|
| Hospital Charge Code |
6151101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
DRAIN BLADDER BY TROCAR/CATH
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 51101
|
| Hospital Charge Code |
6151101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$1,932.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$966.05
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: GEHA Medicare |
$966.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$1,062.65
|
| Rate for Payer: Humana Medicare Advantage |
$966.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,622.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$966.05
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,642.29
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$966.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,932.10
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$946.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$966.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$966.05
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Medicare |
$821.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,159.26
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
DRAIN BREAST LESION ADD-ON
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
6119001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: First Health Workers Compensation |
$26.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$48.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Worker's Compensation |
$18.84
|
|
|
DRAIN BREAST LESION ADD-ON
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
6119001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$152.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$152.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$121.04
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: First Health Workers Compensation |
$26.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$55.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Humana ChoiceCare |
$17.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$123.51
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$41.40
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$142.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$123.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.50
|
| Rate for Payer: Zelis Worker's Compensation |
$18.84
|
|
|
DRAIN CATH EXCHANGE
|
Facility
|
OP
|
$3,548.00
|
|
| Hospital Charge Code |
2407199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.00 |
| Max. Negotiated Rate |
$3,370.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,128.80
|
| Rate for Payer: Cash Price |
$2,128.80
|
| Rate for Payer: Cigna Commercial |
$3,015.80
|
| Rate for Payer: First Health Commercial |
$3,193.20
|
| Rate for Payer: First Health Workers Compensation |
$1,369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,193.20
|
| Rate for Payer: GEHA Commercial |
$2,838.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,193.20
|
| Rate for Payer: Humana ChoiceCare |
$922.48
|
| Rate for Payer: Multiplan All |
$3,228.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,128.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,483.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,193.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,370.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,122.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$887.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,299.64
|
| Rate for Payer: Zelis Auto |
$1,419.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,774.00
|
| Rate for Payer: Zelis Worker's Compensation |
$968.60
|
|
|
DRAIN CATH EXCHANGE
|
Facility
|
IP
|
$3,548.00
|
|
| Hospital Charge Code |
2407199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$968.60 |
| Max. Negotiated Rate |
$3,370.60 |
| Rate for Payer: Cash Price |
$2,128.80
|
| Rate for Payer: Cigna Commercial |
$3,015.80
|
| Rate for Payer: First Health Commercial |
$3,193.20
|
| Rate for Payer: First Health Workers Compensation |
$1,369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,193.20
|
| Rate for Payer: GEHA Commercial |
$2,483.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,193.20
|
| Rate for Payer: Multiplan All |
$3,228.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,483.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,193.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,370.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,299.64
|
| Rate for Payer: Zelis Auto |
$1,419.20
|
| Rate for Payer: Zelis Worker's Compensation |
$968.60
|
|
|
DRAIN CEREBRO SPINAL FLUID
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
6162272
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$515.10
|
| Rate for Payer: First Health Commercial |
$545.40
|
| Rate for Payer: First Health Workers Compensation |
$233.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$545.40
|
| Rate for Payer: GEHA Commercial |
$484.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$545.40
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$551.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$424.20
|
| Rate for Payer: One Health Plan PPO/POS |
$545.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$575.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$454.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$563.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$242.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$165.44
|
|
|
DRAIN CEREBRO SPINAL FLUID
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
6162272
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$515.10
|
| Rate for Payer: First Health Commercial |
$545.40
|
| Rate for Payer: First Health Workers Compensation |
$233.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$545.40
|
| Rate for Payer: GEHA Commercial |
$424.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$545.40
|
| Rate for Payer: Multiplan All |
$551.46
|
| Rate for Payer: OMNI Networks Commercial |
$424.20
|
| Rate for Payer: One Health Plan PPO/POS |
$545.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$575.70
|
| Rate for Payer: Three Rivers Provider Network All |
$454.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$563.58
|
| Rate for Payer: Zelis Auto |
$242.40
|
| Rate for Payer: Zelis Worker's Compensation |
$165.44
|
|
|
DRAIN CHEST LESION
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 21502
|
| Hospital Charge Code |
6121502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$1,046.90 |
| Rate for Payer: Cash Price |
$661.20
|
| Rate for Payer: Cigna Commercial |
$936.70
|
| Rate for Payer: First Health Commercial |
$991.80
|
| Rate for Payer: First Health Workers Compensation |
$425.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$991.80
|
| Rate for Payer: GEHA Commercial |
$771.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$991.80
|
| Rate for Payer: Multiplan All |
$1,002.82
|
| Rate for Payer: OMNI Networks Commercial |
$771.40
|
| Rate for Payer: One Health Plan PPO/POS |
$991.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,046.90
|
| Rate for Payer: Three Rivers Provider Network All |
$826.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,024.86
|
| Rate for Payer: Zelis Auto |
$440.80
|
| Rate for Payer: Zelis Worker's Compensation |
$300.85
|
|
