|
IBUPROFEN 800MG TAB
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3300444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
IBUTILIDE FUMARATE 1MG/10ML INJECTION
|
Facility
|
OP
|
$3,407.00
|
|
|
Service Code
|
CPT J1742
|
| Hospital Charge Code |
3300445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$3,236.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$172.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,044.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$172.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$136.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.31
|
| Rate for Payer: Cash Price |
$2,044.20
|
| Rate for Payer: Cash Price |
$2,044.20
|
| Rate for Payer: Cigna Commercial |
$2,895.95
|
| Rate for Payer: First Health Commercial |
$3,066.30
|
| Rate for Payer: First Health Workers Compensation |
$1,315.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,066.30
|
| Rate for Payer: GEHA Commercial |
$2,725.60
|
| Rate for Payer: GEHA Medicare |
$172.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,066.30
|
| Rate for Payer: Humana ChoiceCare |
$189.54
|
| Rate for Payer: Humana Medicare Advantage |
$172.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$289.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$139.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.31
|
| Rate for Payer: Multiplan All |
$3,100.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,384.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,066.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$160.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$139.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,236.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$344.62
|
| Rate for Payer: Three Rivers Provider Network All |
$2,555.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,168.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.31
|
| Rate for Payer: Zelis Auto |
$1,362.80
|
| Rate for Payer: Zelis Medicare |
$146.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$206.77
|
| Rate for Payer: Zelis Worker's Compensation |
$930.11
|
|
|
IBUTILIDE FUMARATE 1MG/10ML INJECTION
|
Facility
|
IP
|
$3,407.00
|
|
|
Service Code
|
CPT J1742
|
| Hospital Charge Code |
3300445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$930.11 |
| Max. Negotiated Rate |
$3,236.65 |
| Rate for Payer: Cash Price |
$2,044.20
|
| Rate for Payer: Cigna Commercial |
$2,895.95
|
| Rate for Payer: First Health Commercial |
$3,066.30
|
| Rate for Payer: First Health Workers Compensation |
$1,315.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,066.30
|
| Rate for Payer: GEHA Commercial |
$2,384.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,066.30
|
| Rate for Payer: Multiplan All |
$3,100.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,384.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,066.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,236.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,555.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,168.51
|
| Rate for Payer: Zelis Auto |
$1,362.80
|
| Rate for Payer: Zelis Worker's Compensation |
$930.11
|
|
|
IC- FERRIC CARBOXYMALTOSE 750 MG/ 15 ML
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
CPT J1439
|
| Hospital Charge Code |
3350481
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$930.93 |
| Max. Negotiated Rate |
$3,239.50 |
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$2,898.50
|
| Rate for Payer: First Health Commercial |
$3,069.00
|
| Rate for Payer: First Health Workers Compensation |
$1,316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,069.00
|
| Rate for Payer: GEHA Commercial |
$2,387.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,069.00
|
| Rate for Payer: Multiplan All |
$3,103.10
|
| Rate for Payer: OMNI Networks Commercial |
$2,387.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,069.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,239.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,557.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,171.30
|
| Rate for Payer: Zelis Auto |
$1,364.00
|
| Rate for Payer: Zelis Worker's Compensation |
$930.93
|
|
|
IC- FERRIC CARBOXYMALTOSE 750 MG/ 15 ML
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
CPT J1439
|
| Hospital Charge Code |
3350481
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3,239.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,046.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$2,898.50
|
| Rate for Payer: First Health Commercial |
$3,069.00
|
| Rate for Payer: First Health Workers Compensation |
$1,316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,069.00
|
| Rate for Payer: GEHA Commercial |
$1.22
|
| Rate for Payer: GEHA Medicare |
$1.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,069.00
|
| Rate for Payer: Humana ChoiceCare |
$1.22
|
| Rate for Payer: Humana Medicare Advantage |
$1.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1.11
|
| Rate for Payer: Multiplan All |
$3,103.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,387.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,069.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,239.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,557.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,171.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1.11
|
| Rate for Payer: Zelis Auto |
$1,364.00
|
| Rate for Payer: Zelis Medicare |
$0.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.33
|
| Rate for Payer: Zelis Worker's Compensation |
$930.93
|
|
|
I&D ABSC/CYST/HEM TONGUE
|
Facility
|
OP
|
$2,448.00
|
|
| Hospital Charge Code |
8141000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$2,325.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,468.80
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: First Health Commercial |
$2,203.20
|
| Rate for Payer: First Health Workers Compensation |
$945.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,203.20
|
| Rate for Payer: GEHA Commercial |
$1,958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,203.20
|
| Rate for Payer: Humana ChoiceCare |
$636.48
|
| Rate for Payer: Multiplan All |
$2,227.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,468.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,713.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,203.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,325.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,836.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,154.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$612.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,276.64
|
| Rate for Payer: Zelis Auto |
$979.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,224.00
|
| Rate for Payer: Zelis Worker's Compensation |
$668.30
|
|
|
I&D ABSC/CYST/HEM TONGUE
|
Facility
|
IP
|
$2,448.00
|
|
| Hospital Charge Code |
8141000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.30 |
| Max. Negotiated Rate |
$2,325.60 |
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: First Health Commercial |
$2,203.20
|
| Rate for Payer: First Health Workers Compensation |
$945.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,203.20
|
| Rate for Payer: GEHA Commercial |
$1,713.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,203.20
|
| Rate for Payer: Multiplan All |
$2,227.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,713.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,203.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,325.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,836.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,276.64
|
| Rate for Payer: Zelis Auto |
$979.20
|
| Rate for Payer: Zelis Worker's Compensation |
$668.30
|
|
|
I&D ABSCESS P-SPINE L/S/LS
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT 22015
|
| Hospital Charge Code |
6122015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$478.75 |
| Max. Negotiated Rate |
$1,819.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,149.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$1,627.75
|
| Rate for Payer: First Health Commercial |
$1,723.50
|
| Rate for Payer: First Health Workers Compensation |
$739.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,723.50
|
| Rate for Payer: GEHA Commercial |
$1,532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,723.50
|
| Rate for Payer: Humana ChoiceCare |
$497.90
|
| Rate for Payer: Multiplan All |
$1,742.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,149.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,340.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,723.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,819.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,436.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,685.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$478.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,780.95
|
| Rate for Payer: Zelis Auto |
$766.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$957.50
|
| Rate for Payer: Zelis Worker's Compensation |
$522.79
|
|
|
I&D ABSCESS P-SPINE L/S/LS
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT 22015
|
| Hospital Charge Code |
6122015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$522.79 |
| Max. Negotiated Rate |
$1,819.25 |
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$1,627.75
|
| Rate for Payer: First Health Commercial |
$1,723.50
|
| Rate for Payer: First Health Workers Compensation |
$739.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,723.50
|
| Rate for Payer: GEHA Commercial |
$1,340.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,723.50
|
| Rate for Payer: Multiplan All |
$1,742.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,340.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,723.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,819.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,436.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,780.95
|
| Rate for Payer: Zelis Auto |
$766.00
|
| Rate for Payer: Zelis Worker's Compensation |
$522.79
|
|
|
I&D ABSC PERITONSIL
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
8142700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.74 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: First Health Workers Compensation |
$528.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$958.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Worker's Compensation |
$373.74
|
|
|
I&D ABSC PERITONSIL
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
8142700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.43 |
| Max. Negotiated Rate |
$1,300.55 |
| 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 |
$821.40
|
| 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 |
$220.50
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: First Health Workers Compensation |
$528.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$1,095.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| 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 |
$1,245.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| 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 |
$1,300.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| 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 |
$1,273.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$373.74
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE
|
Facility
|
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
8227301
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$564.29 |
| Max. Negotiated Rate |
$1,963.65 |
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cigna Commercial |
$1,756.95
|
| Rate for Payer: First Health Commercial |
$1,860.30
|
| Rate for Payer: First Health Workers Compensation |
$798.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,860.30
|
| Rate for Payer: GEHA Commercial |
$1,446.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,860.30
|
| Rate for Payer: Multiplan All |
$1,880.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,446.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,860.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,963.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,550.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,922.31
|
| Rate for Payer: Zelis Auto |
$826.80
|
| Rate for Payer: Zelis Worker's Compensation |
$564.29
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE
|
Facility
|
OP
|
$2,067.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
8227301
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$564.29 |
| 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 |
$1,240.20
|
| 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 |
$1,240.20
|
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cigna Commercial |
$1,756.95
|
| Rate for Payer: First Health Commercial |
$1,860.30
|
| Rate for Payer: First Health Workers Compensation |
$798.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,860.30
|
| Rate for Payer: GEHA Commercial |
$1,653.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,860.30
|
| 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 |
$1,880.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,446.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,860.30
|
| 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 |
$1,963.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,550.25
|
| 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 |
$1,922.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$826.80
|
| 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 |
$564.29
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE
|
Facility
|
IP
|
$1,574.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
6127301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.70 |
| Max. Negotiated Rate |
$1,495.30 |
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$1,337.90
|
| Rate for Payer: First Health Commercial |
$1,416.60
|
| Rate for Payer: First Health Workers Compensation |
$607.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,416.60
|
| Rate for Payer: GEHA Commercial |
$1,101.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,416.60
|
| Rate for Payer: Multiplan All |
$1,432.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,101.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,416.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,495.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,180.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,463.82
|
| Rate for Payer: Zelis Auto |
$629.60
|
| Rate for Payer: Zelis Worker's Compensation |
$429.70
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE
|
Facility
|
OP
|
$1,574.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
6127301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.70 |
| 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 |
$944.40
|
| 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 |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$1,337.90
|
| Rate for Payer: First Health Commercial |
$1,416.60
|
| Rate for Payer: First Health Workers Compensation |
$607.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,416.60
|
| Rate for Payer: GEHA Commercial |
$1,259.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,416.60
|
| 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 |
$1,432.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,101.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,416.60
|
| 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 |
$1,495.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,180.50
|
| 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 |
$1,463.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$629.60
|
| 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 |
$429.70
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE
|
Facility
|
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
8827301
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$564.29 |
| Max. Negotiated Rate |
$1,963.65 |
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cigna Commercial |
$1,756.95
|
| Rate for Payer: First Health Commercial |
$1,860.30
|
| Rate for Payer: First Health Workers Compensation |
$798.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,860.30
|
| Rate for Payer: GEHA Commercial |
$1,446.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,860.30
|
| Rate for Payer: Multiplan All |
$1,880.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,446.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,860.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,963.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,550.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,922.31
|
| Rate for Payer: Zelis Auto |
$826.80
|
| Rate for Payer: Zelis Worker's Compensation |
$564.29
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE
|
Facility
|
OP
|
$2,067.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
8827301
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$564.29 |
| 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 |
$1,240.20
|
| 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 |
$1,240.20
|
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cigna Commercial |
$1,756.95
|
| Rate for Payer: First Health Commercial |
$1,860.30
|
| Rate for Payer: First Health Workers Compensation |
$798.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,860.30
|
| Rate for Payer: GEHA Commercial |
$1,653.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,860.30
|
| 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 |
$1,880.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,446.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,860.30
|
| 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 |
$1,963.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,550.25
|
| 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 |
$1,922.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$826.80
|
| 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 |
$564.29
|
|
|
I&D DEEP ABSC/HEMATOMA SOFT TISS NECK/TH
|
Facility
|
OP
|
$5,128.00
|
|
| Hospital Charge Code |
8121501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,282.00 |
| Max. Negotiated Rate |
$4,871.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,076.80
|
| Rate for Payer: Cash Price |
$3,076.80
|
| Rate for Payer: Cigna Commercial |
$4,358.80
|
| Rate for Payer: First Health Commercial |
$4,615.20
|
| Rate for Payer: First Health Workers Compensation |
$1,979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,615.20
|
| Rate for Payer: GEHA Commercial |
$4,102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,615.20
|
| Rate for Payer: Humana ChoiceCare |
$1,333.28
|
| Rate for Payer: Multiplan All |
$4,666.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,076.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,589.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,615.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,871.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,846.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,512.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,769.04
|
| Rate for Payer: Zelis Auto |
$2,051.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,564.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,399.94
|
|
|
I&D DEEP ABSC/HEMATOMA SOFT TISS NECK/TH
|
Facility
|
IP
|
$5,128.00
|
|
| Hospital Charge Code |
8121501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,399.94 |
| Max. Negotiated Rate |
$4,871.60 |
| Rate for Payer: Cash Price |
$3,076.80
|
| Rate for Payer: Cigna Commercial |
$4,358.80
|
| Rate for Payer: First Health Commercial |
$4,615.20
|
| Rate for Payer: First Health Workers Compensation |
$1,979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,615.20
|
| Rate for Payer: GEHA Commercial |
$3,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,615.20
|
| Rate for Payer: Multiplan All |
$4,666.48
|
| Rate for Payer: OMNI Networks Commercial |
$3,589.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,615.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,871.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,846.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,769.04
|
| Rate for Payer: Zelis Auto |
$2,051.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,399.94
|
|
|
I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Facility
|
OP
|
$6,145.53
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
8154700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,653.37 |
| Max. Negotiated Rate |
$5,838.25 |
| 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 |
$3,687.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$3,687.32
|
| Rate for Payer: Cash Price |
$3,687.32
|
| Rate for Payer: Cigna Commercial |
$5,223.70
|
| Rate for Payer: First Health Commercial |
$5,530.98
|
| Rate for Payer: First Health Workers Compensation |
$2,372.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,530.98
|
| Rate for Payer: GEHA Commercial |
$4,916.42
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,530.98
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$5,592.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$4,301.87
|
| Rate for Payer: One Health Plan PPO/POS |
$5,530.98
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,838.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$4,609.15
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,715.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$2,458.21
|
| 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 |
$1,677.73
|
|
|
I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Facility
|
IP
|
$6,145.53
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
8154700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,677.73 |
| Max. Negotiated Rate |
$5,838.25 |
| Rate for Payer: Cash Price |
$3,687.32
|
| Rate for Payer: Cigna Commercial |
$5,223.70
|
| Rate for Payer: First Health Commercial |
$5,530.98
|
| Rate for Payer: First Health Workers Compensation |
$2,372.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,530.98
|
| Rate for Payer: GEHA Commercial |
$4,301.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,530.98
|
| Rate for Payer: Multiplan All |
$5,592.43
|
| Rate for Payer: OMNI Networks Commercial |
$4,301.87
|
| Rate for Payer: One Health Plan PPO/POS |
$5,530.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,838.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,609.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,715.34
|
| Rate for Payer: Zelis Auto |
$2,458.21
|
| Rate for Payer: Zelis Worker's Compensation |
$1,677.73
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$4,790.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8810140
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,307.67 |
| Max. Negotiated Rate |
$4,550.50 |
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$4,071.50
|
| Rate for Payer: First Health Commercial |
$4,311.00
|
| Rate for Payer: First Health Workers Compensation |
$1,849.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,311.00
|
| Rate for Payer: GEHA Commercial |
$3,353.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,311.00
|
| Rate for Payer: Multiplan All |
$4,358.90
|
| Rate for Payer: OMNI Networks Commercial |
$3,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,311.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,550.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,592.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,454.70
|
| Rate for Payer: Zelis Auto |
$1,916.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,307.67
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
OP
|
$4,790.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8810140
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,010.98 |
| Max. Negotiated Rate |
$4,550.50 |
| 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 |
$2,874.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$4,071.50
|
| Rate for Payer: First Health Commercial |
$4,311.00
|
| Rate for Payer: First Health Workers Compensation |
$1,849.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,311.00
|
| Rate for Payer: GEHA Commercial |
$3,832.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,311.00
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$4,358.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,311.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,550.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,592.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,454.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,916.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,307.67
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$4,790.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8210140
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,307.67 |
| Max. Negotiated Rate |
$4,550.50 |
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$4,071.50
|
| Rate for Payer: First Health Commercial |
$4,311.00
|
| Rate for Payer: First Health Workers Compensation |
$1,849.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,311.00
|
| Rate for Payer: GEHA Commercial |
$3,353.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,311.00
|
| Rate for Payer: Multiplan All |
$4,358.90
|
| Rate for Payer: OMNI Networks Commercial |
$3,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,311.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,550.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,592.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,454.70
|
| Rate for Payer: Zelis Auto |
$1,916.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,307.67
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
20300012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$301.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$427.55
|
| Rate for Payer: First Health Commercial |
$452.70
|
| Rate for Payer: First Health Workers Compensation |
$194.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$452.70
|
| Rate for Payer: GEHA Commercial |
$402.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$201.20
|
| 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 |
$137.32
|
|
