|
INCISE INNER EAR
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
6169801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
INCISE INNER EAR
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
6169801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$2,870.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,435.33
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$313.60
|
| Rate for Payer: GEHA Medicare |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Humana ChoiceCare |
$1,578.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,411.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Medicare |
$1,220.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
INCISE NERVE BACK OF HEAD
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 64744
|
| Hospital Charge Code |
6164744
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.92 |
| Max. Negotiated Rate |
$977.55 |
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cigna Commercial |
$874.65
|
| Rate for Payer: First Health Commercial |
$926.10
|
| Rate for Payer: First Health Workers Compensation |
$397.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$926.10
|
| Rate for Payer: GEHA Commercial |
$720.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$926.10
|
| Rate for Payer: Multiplan All |
$936.39
|
| Rate for Payer: OMNI Networks Commercial |
$720.30
|
| Rate for Payer: One Health Plan PPO/POS |
$926.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$977.55
|
| Rate for Payer: Three Rivers Provider Network All |
$771.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.97
|
| Rate for Payer: Zelis Auto |
$411.60
|
| Rate for Payer: Zelis Worker's Compensation |
$280.92
|
|
|
INCISE NERVE BACK OF HEAD
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 64744
|
| Hospital Charge Code |
6164744
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.92 |
| Max. Negotiated Rate |
$3,784.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$617.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,892.20
|
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cigna Commercial |
$874.65
|
| Rate for Payer: First Health Commercial |
$926.10
|
| Rate for Payer: First Health Workers Compensation |
$397.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$926.10
|
| Rate for Payer: GEHA Commercial |
$823.20
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$926.10
|
| Rate for Payer: Humana ChoiceCare |
$2,081.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,178.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,892.20
|
| Rate for Payer: Multiplan All |
$936.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$720.30
|
| Rate for Payer: One Health Plan PPO/POS |
$926.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$977.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$771.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,892.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$411.60
|
| Rate for Payer: Zelis Medicare |
$1,608.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,270.64
|
| Rate for Payer: Zelis Worker's Compensation |
$280.92
|
|
|
INCISE SPERM DUCT POUCH
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 55600
|
| Hospital Charge Code |
6155600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$3,969.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$692.00
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$346.00
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$236.15
|
|
|
INCISE SPERM DUCT POUCH
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 55600
|
| Hospital Charge Code |
6155600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$605.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: Zelis Auto |
$346.00
|
| Rate for Payer: Zelis Worker's Compensation |
$236.15
|
|
|
INCISE SPERM DUCT POUCH
|
Facility
|
IP
|
$1,127.00
|
|
|
Service Code
|
CPT 55605
|
| Hospital Charge Code |
6155605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.67 |
| Max. Negotiated Rate |
$1,070.65 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cigna Commercial |
$957.95
|
| Rate for Payer: First Health Commercial |
$1,014.30
|
| Rate for Payer: First Health Workers Compensation |
$435.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,014.30
|
| Rate for Payer: GEHA Commercial |
$788.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,014.30
|
| Rate for Payer: Multiplan All |
$1,025.57
|
| Rate for Payer: OMNI Networks Commercial |
$788.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,014.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,070.65
|
| Rate for Payer: Three Rivers Provider Network All |
$845.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,048.11
|
| Rate for Payer: Zelis Auto |
$450.80
|
| Rate for Payer: Zelis Worker's Compensation |
$307.67
|
|
|
INCISE SPERM DUCT POUCH
|
Facility
|
OP
|
$1,127.00
|
|
|
Service Code
|
CPT 55605
|
| Hospital Charge Code |
6155605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$1,070.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cigna Commercial |
$957.95
|
| Rate for Payer: First Health Commercial |
$1,014.30
|
| Rate for Payer: First Health Workers Compensation |
$435.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,014.30
|
| Rate for Payer: GEHA Commercial |
$901.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,014.30
|
| Rate for Payer: Humana ChoiceCare |
$293.02
|
| Rate for Payer: Multiplan All |
$1,025.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$676.20
|
| Rate for Payer: OMNI Networks Commercial |
$788.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,014.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,070.65
|
| Rate for Payer: Three Rivers Provider Network All |
$845.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$991.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$281.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,048.11
|
| Rate for Payer: Zelis Auto |
$450.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$563.50
|
| Rate for Payer: Zelis Worker's Compensation |
$307.67
|
|
|
INCISE SPINAL CORD TRACT(S)
|
Facility
|
OP
|
$3,436.00
|
|
|
Service Code
|
CPT 63170
|
| Hospital Charge Code |
6163170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$859.00 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: First Health Workers Compensation |
$1,326.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,748.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Humana ChoiceCare |
$893.36
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,061.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,023.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$859.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,718.00
|
| Rate for Payer: Zelis Worker's Compensation |
$938.03
|
|
|
INCISE SPINAL CORD TRACT(S)
|
Facility
|
IP
|
$3,436.00
|
|
|
Service Code
|
CPT 63170
|
| Hospital Charge Code |
6163170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$938.03 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: First Health Workers Compensation |
$1,326.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,405.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
| Rate for Payer: Zelis Worker's Compensation |
$938.03
|
|
|
INCISE TENDON(S) & MUSCLE(S)
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
CPT 23406
|
| Hospital Charge Code |
6123406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.98 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$945.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,260.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,433.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,464.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
INCISE TENDON(S) & MUSCLE(S)
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 23406
|
| Hospital Charge Code |
6123406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.98 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,102.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| Rate for Payer: Multiplan All |
$1,433.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,464.75
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
INCISE THIGH TENDON & FASCIA
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 27305
|
| Hospital Charge Code |
6127305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$587.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$783.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
INCISE THIGH TENDON & FASCIA
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 27305
|
| Hospital Charge Code |
6127305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$930.05 |
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$685.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
INCISE & TREAT BLADDER
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 51020
|
| Hospital Charge Code |
6151020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.35 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$371.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$672.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.95
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Worker's Compensation |
$262.35
|
|
|
INCISE & TREAT BLADDER
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 51030
|
| Hospital Charge Code |
6151030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$2,580.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$584.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$827.90
|
| Rate for Payer: First Health Commercial |
$876.60
|
| Rate for Payer: First Health Workers Compensation |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$779.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| Rate for Payer: Humana ChoiceCare |
$253.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Multiplan All |
$886.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$584.40
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$925.30
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$857.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$905.82
|
| Rate for Payer: Zelis Auto |
$389.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$487.00
|
| Rate for Payer: Zelis Worker's Compensation |
$265.90
|
|
|
INCISE & TREAT BLADDER
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 51020
|
| Hospital Charge Code |
6151020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.35 |
| Max. Negotiated Rate |
$6,683.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$576.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,341.98
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$371.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$768.80
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$262.35
|
|
|
INCISE & TREAT BLADDER
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 51030
|
| Hospital Charge Code |
6151030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.90 |
| Max. Negotiated Rate |
$925.30 |
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$827.90
|
| Rate for Payer: First Health Commercial |
$876.60
|
| Rate for Payer: First Health Workers Compensation |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$681.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| Rate for Payer: Multiplan All |
$886.34
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$925.30
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$905.82
|
| Rate for Payer: Zelis Auto |
$389.60
|
| Rate for Payer: Zelis Worker's Compensation |
$265.90
|
|
|
INCISE WRIST/FOREARM TENDON
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 25290
|
| Hospital Charge Code |
6125290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$530.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$707.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
INCISE WRIST/FOREARM TENDON
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 25290
|
| Hospital Charge Code |
6125290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$618.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
INCISIONAL BIOPSY OF SKIN; SINGLE LESION
|
Facility
|
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
6111106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$718.54 |
| Max. Negotiated Rate |
$2,500.40 |
| Rate for Payer: Cash Price |
$1,579.20
|
| Rate for Payer: Cigna Commercial |
$2,237.20
|
| Rate for Payer: First Health Commercial |
$2,368.80
|
| Rate for Payer: First Health Workers Compensation |
$1,016.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,368.80
|
| Rate for Payer: GEHA Commercial |
$1,842.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,368.80
|
| Rate for Payer: Multiplan All |
$2,395.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,842.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,368.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,500.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,974.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,447.76
|
| Rate for Payer: Zelis Auto |
$1,052.80
|
| Rate for Payer: Zelis Worker's Compensation |
$718.54
|
|
|
INCISIONAL BIOPSY OF SKIN; SINGLE LESION
|
Facility
|
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
6111106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$2,500.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$471.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,579.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$471.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$373.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$593.14
|
| Rate for Payer: Cash Price |
$1,579.20
|
| Rate for Payer: Cash Price |
$1,579.20
|
| Rate for Payer: Cigna Commercial |
$2,237.20
|
| Rate for Payer: First Health Commercial |
$2,368.80
|
| Rate for Payer: First Health Workers Compensation |
$1,016.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,368.80
|
| Rate for Payer: GEHA Commercial |
$2,105.60
|
| Rate for Payer: GEHA Medicare |
$593.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,368.80
|
| Rate for Payer: Humana ChoiceCare |
$652.45
|
| Rate for Payer: Humana Medicare Advantage |
$593.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$996.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$380.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$593.14
|
| Rate for Payer: Multiplan All |
$2,395.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,008.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,842.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,368.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$439.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$380.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$593.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,500.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,186.28
|
| Rate for Payer: Three Rivers Provider Network All |
$1,974.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$581.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$593.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,447.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$593.14
|
| Rate for Payer: Zelis Auto |
$1,052.80
|
| Rate for Payer: Zelis Medicare |
$504.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.77
|
| Rate for Payer: Zelis Worker's Compensation |
$718.54
|
|
|
INCISIONAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
21600217
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
INCISIONAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
OP
|
$191.40
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
7211107
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$47.85 |
| Max. Negotiated Rate |
$181.83 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.84
|
| Rate for Payer: Cash Price |
$114.84
|
| Rate for Payer: Cigna Commercial |
$162.69
|
| Rate for Payer: First Health Commercial |
$172.26
|
| Rate for Payer: First Health Workers Compensation |
$73.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.26
|
| Rate for Payer: GEHA Commercial |
$153.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.26
|
| Rate for Payer: Humana ChoiceCare |
$49.76
|
| Rate for Payer: Multiplan All |
$174.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.84
|
| Rate for Payer: OMNI Networks Commercial |
$133.98
|
| Rate for Payer: One Health Plan PPO/POS |
$172.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.83
|
| Rate for Payer: Three Rivers Provider Network All |
$143.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.00
|
| Rate for Payer: Zelis Auto |
$76.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.70
|
| Rate for Payer: Zelis Worker's Compensation |
$52.25
|
|
|
INCISIONAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
20300148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
