|
DRAIN OPEN RETROP ABSCESS
|
Facility
|
IP
|
$2,312.00
|
|
|
Service Code
|
CPT 49060
|
| Hospital Charge Code |
6149060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$631.18 |
| Max. Negotiated Rate |
$2,196.40 |
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cigna Commercial |
$1,965.20
|
| Rate for Payer: First Health Commercial |
$2,080.80
|
| Rate for Payer: First Health Workers Compensation |
$892.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,080.80
|
| Rate for Payer: GEHA Commercial |
$1,618.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,080.80
|
| Rate for Payer: Multiplan All |
$2,103.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,618.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,080.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,196.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,734.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,150.16
|
| Rate for Payer: Zelis Auto |
$924.80
|
| Rate for Payer: Zelis Worker's Compensation |
$631.18
|
|
|
DRAIN OPEN RETROP ABSCESS
|
Facility
|
OP
|
$2,312.00
|
|
|
Service Code
|
CPT 49060
|
| Hospital Charge Code |
6149060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$2,196.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cigna Commercial |
$1,965.20
|
| Rate for Payer: First Health Commercial |
$2,080.80
|
| Rate for Payer: First Health Workers Compensation |
$892.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,080.80
|
| Rate for Payer: GEHA Commercial |
$1,849.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,080.80
|
| Rate for Payer: Humana ChoiceCare |
$601.12
|
| Rate for Payer: Multiplan All |
$2,103.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,387.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,618.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,080.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,196.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,734.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,034.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$578.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,150.16
|
| Rate for Payer: Zelis Auto |
$924.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$631.18
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6169020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$301.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6169020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$344.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
DRAIN PANCREATIC PSEUDOCYST
|
Facility
|
IP
|
$2,281.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
6148510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$622.71 |
| Max. Negotiated Rate |
$2,166.95 |
| Rate for Payer: Cash Price |
$1,368.60
|
| Rate for Payer: Cigna Commercial |
$1,938.85
|
| Rate for Payer: First Health Commercial |
$2,052.90
|
| Rate for Payer: First Health Workers Compensation |
$880.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,052.90
|
| Rate for Payer: GEHA Commercial |
$1,596.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,052.90
|
| Rate for Payer: Multiplan All |
$2,075.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,596.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,052.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,166.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,710.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,121.33
|
| Rate for Payer: Zelis Auto |
$912.40
|
| Rate for Payer: Zelis Worker's Compensation |
$622.71
|
|
|
DRAIN PANCREATIC PSEUDOCYST
|
Facility
|
OP
|
$2,281.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
6148510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$570.25 |
| Max. Negotiated Rate |
$2,166.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,368.60
|
| Rate for Payer: Cash Price |
$1,368.60
|
| Rate for Payer: Cigna Commercial |
$1,938.85
|
| Rate for Payer: First Health Commercial |
$2,052.90
|
| Rate for Payer: First Health Workers Compensation |
$880.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,052.90
|
| Rate for Payer: GEHA Commercial |
$1,824.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,052.90
|
| Rate for Payer: Humana ChoiceCare |
$593.06
|
| Rate for Payer: Multiplan All |
$2,075.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,368.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,596.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,052.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,166.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,710.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,007.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$570.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,121.33
|
| Rate for Payer: Zelis Auto |
$912.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,140.50
|
| Rate for Payer: Zelis Worker's Compensation |
$622.71
|
|
|
DRAIN PENIS LESION
|
Facility
|
IP
|
$798.00
|
|
|
Service Code
|
CPT 54015
|
| Hospital Charge Code |
6154015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$217.85 |
| Max. Negotiated Rate |
$758.10 |
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: First Health Commercial |
$718.20
|
| Rate for Payer: First Health Workers Compensation |
$308.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$718.20
|
| Rate for Payer: GEHA Commercial |
$558.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$718.20
|
| Rate for Payer: Multiplan All |
$726.18
|
| Rate for Payer: OMNI Networks Commercial |
$558.60
|
| Rate for Payer: One Health Plan PPO/POS |
$718.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$758.10
|
| Rate for Payer: Three Rivers Provider Network All |
$598.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$742.14
|
| Rate for Payer: Zelis Auto |
$319.20
|
| Rate for Payer: Zelis Worker's Compensation |
$217.85
|
|
|
DRAIN PENIS LESION
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
CPT 54015
|
| Hospital Charge Code |
6154015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$217.85 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: First Health Commercial |
$718.20
|
| Rate for Payer: First Health Workers Compensation |
$308.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$718.20
|
| Rate for Payer: GEHA Commercial |
$638.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$718.20
|
| 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 |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$726.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$558.60
|
| Rate for Payer: One Health Plan PPO/POS |
$718.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$758.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$598.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$742.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$319.20
|
| 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 |
$217.85
|
|
|
DRAIN PERC ABCS RETR
|
Facility
|
OP
|
$2,995.00
|
|
| Hospital Charge Code |
2407195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$748.75 |
| Max. Negotiated Rate |
$2,845.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,797.00
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$2,545.75
|
| Rate for Payer: First Health Commercial |
$2,695.50
|
| Rate for Payer: First Health Workers Compensation |
$1,156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,695.50
|
| Rate for Payer: GEHA Commercial |
$2,396.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,695.50
|
| Rate for Payer: Humana ChoiceCare |
$778.70
|
| Rate for Payer: Multiplan All |
$2,725.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,797.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,096.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,695.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,845.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,246.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,635.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$748.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,785.35
|
| Rate for Payer: Zelis Auto |
$1,198.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,497.50
|
| Rate for Payer: Zelis Worker's Compensation |
$817.63
|
|
|
DRAIN PERC ABCS RETR
|
Facility
|
IP
|
$2,995.00
|
|
| Hospital Charge Code |
2407195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$817.63 |
| Max. Negotiated Rate |
$2,845.25 |
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$2,545.75
|
| Rate for Payer: First Health Commercial |
$2,695.50
|
| Rate for Payer: First Health Workers Compensation |
$1,156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,695.50
|
| Rate for Payer: GEHA Commercial |
$2,096.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,695.50
|
| Rate for Payer: Multiplan All |
$2,725.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,096.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,695.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,845.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,246.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,785.35
|
| Rate for Payer: Zelis Auto |
$1,198.00
|
| Rate for Payer: Zelis Worker's Compensation |
$817.63
|
|
|
DRAIN PERC RENAL ABS
|
Facility
|
OP
|
$3,356.00
|
|
| Hospital Charge Code |
2407196
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$839.00 |
| Max. Negotiated Rate |
$3,188.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,013.60
|
| Rate for Payer: Cash Price |
$2,013.60
|
| Rate for Payer: Cigna Commercial |
$2,852.60
|
| Rate for Payer: First Health Commercial |
$3,020.40
|
| Rate for Payer: First Health Workers Compensation |
$1,295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,020.40
|
| Rate for Payer: GEHA Commercial |
$2,684.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,020.40
|
| Rate for Payer: Humana ChoiceCare |
$872.56
|
| Rate for Payer: Multiplan All |
$3,053.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,013.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,349.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,020.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,188.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,517.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,953.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$839.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,121.08
|
| Rate for Payer: Zelis Auto |
$1,342.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,678.00
|
| Rate for Payer: Zelis Worker's Compensation |
$916.19
|
|
|
DRAIN PERC RENAL ABS
|
Facility
|
IP
|
$3,356.00
|
|
| Hospital Charge Code |
2407196
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$916.19 |
| Max. Negotiated Rate |
$3,188.20 |
| Rate for Payer: Cash Price |
$2,013.60
|
| Rate for Payer: Cigna Commercial |
$2,852.60
|
| Rate for Payer: First Health Commercial |
$3,020.40
|
| Rate for Payer: First Health Workers Compensation |
$1,295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,020.40
|
| Rate for Payer: GEHA Commercial |
$2,349.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,020.40
|
| Rate for Payer: Multiplan All |
$3,053.96
|
| Rate for Payer: OMNI Networks Commercial |
$2,349.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,020.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,188.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,517.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,121.08
|
| Rate for Payer: Zelis Auto |
$1,342.40
|
| Rate for Payer: Zelis Worker's Compensation |
$916.19
|
|
|
DRAIN PUNCT LESION
|
Facility
|
IP
|
$883.00
|
|
| Hospital Charge Code |
2407208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: First Health Workers Compensation |
$340.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$618.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Worker's Compensation |
$241.06
|
|
|
DRAIN PUNCT LESION
|
Facility
|
OP
|
$883.00
|
|
| Hospital Charge Code |
2407208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.75 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: First Health Workers Compensation |
$340.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$706.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Humana ChoiceCare |
$229.58
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$529.80
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$777.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$441.50
|
| Rate for Payer: Zelis Worker's Compensation |
$241.06
|
|
|
DRAIN SHOULDER BONE LESION
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 23035
|
| Hospital Charge Code |
6123035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.83 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$830.40
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cigna Commercial |
$1,176.40
|
| Rate for Payer: First Health Commercial |
$1,245.60
|
| Rate for Payer: First Health Workers Compensation |
$534.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,245.60
|
| Rate for Payer: GEHA Commercial |
$1,107.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,245.60
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,259.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$968.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,245.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,314.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,038.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,287.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$553.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$377.83
|
|
|
DRAIN SHOULDER BONE LESION
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 23035
|
| Hospital Charge Code |
6123035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.83 |
| Max. Negotiated Rate |
$1,314.80 |
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cigna Commercial |
$1,176.40
|
| Rate for Payer: First Health Commercial |
$1,245.60
|
| Rate for Payer: First Health Workers Compensation |
$534.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,245.60
|
| Rate for Payer: GEHA Commercial |
$968.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,245.60
|
| Rate for Payer: Multiplan All |
$1,259.44
|
| Rate for Payer: OMNI Networks Commercial |
$968.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,245.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,314.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,038.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,287.12
|
| Rate for Payer: Zelis Auto |
$553.60
|
| Rate for Payer: Zelis Worker's Compensation |
$377.83
|
|
|
DRAIN SHOULDER BURSA
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 23031
|
| Hospital Charge Code |
6123031
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
DRAIN SHOULDER BURSA
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 23031
|
| Hospital Charge Code |
6123031
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$391.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
DRAIN SHOULDER LESION
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
6123030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
DRAIN SHOULDER LESION
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
6123030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$524.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
DRAIN THYROID/TONGUE CYST
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
6160000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.49 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| 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 |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$186.80
|
| 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 |
$127.49
|
|
|
DRAIN THYROID/TONGUE CYST
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
6160000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.49 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
DRAIN TO PERITONEAL CAVITY
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 49062
|
| Hospital Charge Code |
6149062
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$385.50 |
| Max. Negotiated Rate |
$1,464.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$925.20
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cigna Commercial |
$1,310.70
|
| Rate for Payer: First Health Commercial |
$1,387.80
|
| Rate for Payer: First Health Workers Compensation |
$595.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,387.80
|
| Rate for Payer: GEHA Commercial |
$1,233.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,387.80
|
| Rate for Payer: Humana ChoiceCare |
$400.92
|
| Rate for Payer: Multiplan All |
$1,403.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$925.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,079.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,387.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,464.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,156.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,356.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.06
|
| Rate for Payer: Zelis Auto |
$616.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$771.00
|
| Rate for Payer: Zelis Worker's Compensation |
$420.97
|
|
|
DRAIN TO PERITONEAL CAVITY
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 49062
|
| Hospital Charge Code |
6149062
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.97 |
| Max. Negotiated Rate |
$1,464.90 |
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cigna Commercial |
$1,310.70
|
| Rate for Payer: First Health Commercial |
$1,387.80
|
| Rate for Payer: First Health Workers Compensation |
$595.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,387.80
|
| Rate for Payer: GEHA Commercial |
$1,079.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,387.80
|
| Rate for Payer: Multiplan All |
$1,403.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,079.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,387.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,464.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,156.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.06
|
| Rate for Payer: Zelis Auto |
$616.80
|
| Rate for Payer: Zelis Worker's Compensation |
$420.97
|
|
|
DRESS AQUACEL AG NON BORDER 4X5
|
Facility
|
OP
|
$296.00
|
|
| Hospital Charge Code |
90030843
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$76.96
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.60
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$260.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
