|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
6110140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$140.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$99.37
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$6,846.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
1900012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,868.96 |
| Max. Negotiated Rate |
$6,503.70 |
| Rate for Payer: Cash Price |
$4,107.60
|
| Rate for Payer: Cigna Commercial |
$5,819.10
|
| Rate for Payer: First Health Commercial |
$6,161.40
|
| Rate for Payer: First Health Workers Compensation |
$2,643.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,161.40
|
| Rate for Payer: GEHA Commercial |
$4,792.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,161.40
|
| Rate for Payer: Multiplan All |
$6,229.86
|
| Rate for Payer: OMNI Networks Commercial |
$4,792.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,161.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,503.70
|
| Rate for Payer: Three Rivers Provider Network All |
$5,134.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,366.78
|
| Rate for Payer: Zelis Auto |
$2,738.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,868.96
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
OP
|
$4,790.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8110140
|
|
Hospital Revenue Code
|
450
|
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,311.00
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$4,358.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,550.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,592.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,454.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$1,916.00
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$1,307.67
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$467.97
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
7210140
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$444.57 |
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cigna Commercial |
$397.77
|
| Rate for Payer: First Health Commercial |
$421.17
|
| Rate for Payer: First Health Workers Compensation |
$180.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.17
|
| Rate for Payer: GEHA Commercial |
$327.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.17
|
| Rate for Payer: Multiplan All |
$425.85
|
| Rate for Payer: OMNI Networks Commercial |
$327.58
|
| Rate for Payer: One Health Plan PPO/POS |
$421.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.57
|
| Rate for Payer: Three Rivers Provider Network All |
$350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.21
|
| Rate for Payer: Zelis Auto |
$187.19
|
| Rate for Payer: Zelis Worker's Compensation |
$127.76
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
20300012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$477.85 |
| 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 |
$352.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Worker's Compensation |
$137.32
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$4,790.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8110140
|
|
Hospital Revenue Code
|
450
|
| 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 |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$137.32
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$467.97
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8510140
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$444.57 |
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cigna Commercial |
$397.77
|
| Rate for Payer: First Health Commercial |
$421.17
|
| Rate for Payer: First Health Workers Compensation |
$180.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.17
|
| Rate for Payer: GEHA Commercial |
$327.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.17
|
| Rate for Payer: Multiplan All |
$425.85
|
| Rate for Payer: OMNI Networks Commercial |
$327.58
|
| Rate for Payer: One Health Plan PPO/POS |
$421.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.57
|
| Rate for Payer: Three Rivers Provider Network All |
$350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.21
|
| Rate for Payer: Zelis Auto |
$187.19
|
| Rate for Payer: Zelis Worker's Compensation |
$127.76
|
|
|
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
|
$6,846.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
1900012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,010.98 |
| Max. Negotiated Rate |
$6,503.70 |
| 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 |
$4,107.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$4,107.60
|
| Rate for Payer: Cash Price |
$4,107.60
|
| Rate for Payer: Cigna Commercial |
$5,819.10
|
| Rate for Payer: First Health Commercial |
$6,161.40
|
| Rate for Payer: First Health Workers Compensation |
$2,643.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,161.40
|
| Rate for Payer: GEHA Commercial |
$5,476.80
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,161.40
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$6,229.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$4,792.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,161.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,503.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$5,134.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,366.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$2,738.40
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$1,868.96
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9410140
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$137.32
|
|
|
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
|
$467.97
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8510140
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cigna Commercial |
$397.77
|
| Rate for Payer: First Health Commercial |
$421.17
|
| Rate for Payer: First Health Workers Compensation |
$180.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.17
|
| Rate for Payer: GEHA Commercial |
$374.38
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.17
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$425.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$327.58
|
| Rate for Payer: One Health Plan PPO/POS |
$421.17
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.57
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$350.98
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$187.19
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$127.76
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
21600095
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$140.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$254.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Worker's Compensation |
$99.37
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
OP
|
$467.97
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
7210140
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Cigna Commercial |
$397.77
|
| Rate for Payer: First Health Commercial |
$421.17
|
| 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 |
$280.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,276.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: First Health Workers Compensation |
$180.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.17
|
| Rate for Payer: GEHA Commercial |
$374.38
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.17
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$425.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$327.58
|
| Rate for Payer: One Health Plan PPO/POS |
$421.17
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,191.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,031.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.57
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$350.98
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$187.19
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$127.76
|
|
|
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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,311.00
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,031.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$4,358.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,550.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,592.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,454.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$1,916.00
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$1,307.67
|
|
|
I&D, INTRAMRL, IM/ABSC, TRNSANAL, AN PF
|
Facility
|
IP
|
$1,320.06
|
|
|
Service Code
|
CPT 46045
|
| Hospital Charge Code |
6146046
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.38 |
| Max. Negotiated Rate |
$1,254.06 |
| Rate for Payer: Cash Price |
$792.04
|
| Rate for Payer: Cigna Commercial |
$1,122.05
|
| Rate for Payer: First Health Commercial |
$1,188.05
|
| Rate for Payer: First Health Workers Compensation |
$509.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.05
|
| Rate for Payer: GEHA Commercial |
$924.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.05
|
| Rate for Payer: Multiplan All |
$1,201.25
|
| Rate for Payer: OMNI Networks Commercial |
$924.04
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.06
|
| Rate for Payer: Three Rivers Provider Network All |
$990.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.66
|
| Rate for Payer: Zelis Auto |
$528.02
|
| Rate for Payer: Zelis Worker's Compensation |
$360.38
|
|
|
I&D, INTRAMRL, IM/ABSC, TRNSANAL, AN PF
|
Facility
|
OP
|
$1,320.06
|
|
|
Service Code
|
CPT 46045
|
| Hospital Charge Code |
6146046
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.38 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$792.04
|
| Rate for Payer: Cash Price |
$792.04
|
| Rate for Payer: Cigna Commercial |
$1,122.05
|
| Rate for Payer: First Health Commercial |
$1,188.05
|
| Rate for Payer: First Health Workers Compensation |
$509.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.05
|
| Rate for Payer: GEHA Commercial |
$1,056.05
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.05
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,201.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$924.04
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.05
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$990.04
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$528.02
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$360.38
|
|
|
I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
OP
|
$5,698.00
|
|
| Hospital Charge Code |
8146040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,424.50 |
| Max. Negotiated Rate |
$5,413.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,418.80
|
| Rate for Payer: Cash Price |
$3,418.80
|
| Rate for Payer: Cigna Commercial |
$4,843.30
|
| Rate for Payer: First Health Commercial |
$5,128.20
|
| Rate for Payer: First Health Workers Compensation |
$2,200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,128.20
|
| Rate for Payer: GEHA Commercial |
$4,558.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,128.20
|
| Rate for Payer: Humana ChoiceCare |
$1,481.48
|
| Rate for Payer: Multiplan All |
$5,185.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,418.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,988.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,128.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,413.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,273.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,014.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,299.14
|
| Rate for Payer: Zelis Auto |
$2,279.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,849.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,555.55
|
|
|
I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
21600224
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$808.45 |
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cigna Commercial |
$723.35
|
| Rate for Payer: First Health Commercial |
$765.90
|
| Rate for Payer: First Health Workers Compensation |
$328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.90
|
| Rate for Payer: GEHA Commercial |
$595.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.90
|
| Rate for Payer: Multiplan All |
$774.41
|
| Rate for Payer: OMNI Networks Commercial |
$595.70
|
| Rate for Payer: One Health Plan PPO/POS |
$765.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$808.45
|
| Rate for Payer: Three Rivers Provider Network All |
$638.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$791.43
|
| Rate for Payer: Zelis Auto |
$340.40
|
| Rate for Payer: Zelis Worker's Compensation |
$232.32
|
|
|
I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
6146040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$808.45 |
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cigna Commercial |
$723.35
|
| Rate for Payer: First Health Commercial |
$765.90
|
| Rate for Payer: First Health Workers Compensation |
$328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.90
|
| Rate for Payer: GEHA Commercial |
$595.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.90
|
| Rate for Payer: Multiplan All |
$774.41
|
| Rate for Payer: OMNI Networks Commercial |
$595.70
|
| Rate for Payer: One Health Plan PPO/POS |
$765.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$808.45
|
| Rate for Payer: Three Rivers Provider Network All |
$638.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$791.43
|
| Rate for Payer: Zelis Auto |
$340.40
|
| Rate for Payer: Zelis Worker's Compensation |
$232.32
|
|
|
I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
21600224
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$2,423.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$510.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,142.50
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cigna Commercial |
$723.35
|
| Rate for Payer: First Health Commercial |
$765.90
|
| Rate for Payer: First Health Workers Compensation |
$328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.90
|
| Rate for Payer: GEHA Commercial |
$680.80
|
| Rate for Payer: GEHA Medicare |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.90
|
| Rate for Payer: Humana ChoiceCare |
$1,256.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,142.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,919.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,142.50
|
| Rate for Payer: Multiplan All |
$774.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| Rate for Payer: OMNI Networks Commercial |
$595.70
|
| Rate for Payer: One Health Plan PPO/POS |
$765.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$808.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$638.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$791.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$340.40
|
| Rate for Payer: Zelis Medicare |
$971.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.00
|
| Rate for Payer: Zelis Worker's Compensation |
$232.32
|
|
|
I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
IP
|
$5,698.00
|
|
| Hospital Charge Code |
8146040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,555.55 |
| Max. Negotiated Rate |
$5,413.10 |
| Rate for Payer: Cash Price |
$3,418.80
|
| Rate for Payer: Cigna Commercial |
$4,843.30
|
| Rate for Payer: First Health Commercial |
$5,128.20
|
| Rate for Payer: First Health Workers Compensation |
$2,200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,128.20
|
| Rate for Payer: GEHA Commercial |
$3,988.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,128.20
|
| Rate for Payer: Multiplan All |
$5,185.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,988.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,128.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,413.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,299.14
|
| Rate for Payer: Zelis Auto |
$2,279.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,555.55
|
|
|
I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
6146040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$2,423.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$510.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,142.50
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cigna Commercial |
$723.35
|
| Rate for Payer: First Health Commercial |
$765.90
|
| Rate for Payer: First Health Workers Compensation |
$328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.90
|
| Rate for Payer: GEHA Commercial |
$680.80
|
| Rate for Payer: GEHA Medicare |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.90
|
| Rate for Payer: Humana ChoiceCare |
$1,256.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,142.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,919.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,142.50
|
| Rate for Payer: Multiplan All |
$774.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| Rate for Payer: OMNI Networks Commercial |
$595.70
|
| Rate for Payer: One Health Plan PPO/POS |
$765.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$808.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$638.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$791.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$340.40
|
| Rate for Payer: Zelis Medicare |
$971.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.00
|
| Rate for Payer: Zelis Worker's Compensation |
$232.32
|
|
|
I&D OF BARTHOLINS GLAND ABSCESS
|
Facility
|
OP
|
$705.00
|
|
| Hospital Charge Code |
8156420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$669.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$599.25
|
| Rate for Payer: First Health Commercial |
$634.50
|
| Rate for Payer: First Health Workers Compensation |
$272.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$634.50
|
| Rate for Payer: GEHA Commercial |
$564.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$634.50
|
| Rate for Payer: Humana ChoiceCare |
$183.30
|
| Rate for Payer: Multiplan All |
$641.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$423.00
|
| Rate for Payer: OMNI Networks Commercial |
$493.50
|
| Rate for Payer: One Health Plan PPO/POS |
$634.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$669.75
|
| Rate for Payer: Three Rivers Provider Network All |
$528.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$620.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$655.65
|
| Rate for Payer: Zelis Auto |
$282.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$352.50
|
| Rate for Payer: Zelis Worker's Compensation |
$192.47
|
|
