|
INCISION OF ACHILLES TENDON
|
Facility
|
IP
|
$793.11
|
|
|
Service Code
|
CPT 27606
|
| Hospital Charge Code |
6127606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$216.52 |
| Max. Negotiated Rate |
$753.45 |
| Rate for Payer: Cash Price |
$475.87
|
| Rate for Payer: Cigna Commercial |
$674.14
|
| Rate for Payer: First Health Commercial |
$713.80
|
| Rate for Payer: First Health Workers Compensation |
$306.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$713.80
|
| Rate for Payer: GEHA Commercial |
$555.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$713.80
|
| Rate for Payer: Multiplan All |
$721.73
|
| Rate for Payer: OMNI Networks Commercial |
$555.18
|
| Rate for Payer: One Health Plan PPO/POS |
$713.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$753.45
|
| Rate for Payer: Three Rivers Provider Network All |
$594.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$737.59
|
| Rate for Payer: Zelis Auto |
$317.24
|
| Rate for Payer: Zelis Worker's Compensation |
$216.52
|
|
|
INCISION OF ANAL SEPTUM
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 46070
|
| Hospital Charge Code |
6146070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| 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 |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$229.60
|
| 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 |
$156.70
|
|
|
INCISION OF ANAL SEPTUM
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 46070
|
| Hospital Charge Code |
6146070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$401.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: Zelis Auto |
$229.60
|
| Rate for Payer: Zelis Worker's Compensation |
$156.70
|
|
|
INCISION OF ANAL SPHINCTER
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 46080
|
| Hospital Charge Code |
6146080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: First Health Workers Compensation |
$191.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$347.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: Zelis Auto |
$198.80
|
| Rate for Payer: Zelis Worker's Compensation |
$135.68
|
|
|
INCISION OF ANAL SPHINCTER
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 46080
|
| Hospital Charge Code |
6146080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.68 |
| 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 |
$298.20
|
| 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 |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: First Health Workers Compensation |
$191.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| 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 |
$452.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| 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 |
$472.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| 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 |
$462.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$198.80
|
| 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 |
$135.68
|
|
|
INCISION OF ANKLE BONE
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT 28302
|
| Hospital Charge Code |
6128302
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.76 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$880.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$1,247.80
|
| Rate for Payer: First Health Commercial |
$1,321.20
|
| Rate for Payer: First Health Workers Compensation |
$566.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,321.20
|
| Rate for Payer: GEHA Commercial |
$1,174.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,321.20
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,335.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,027.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,321.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,394.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,365.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$587.20
|
| 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 |
$400.76
|
|
|
INCISION OF ANKLE BONE
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT 28302
|
| Hospital Charge Code |
6128302
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.76 |
| Max. Negotiated Rate |
$1,394.60 |
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$1,247.80
|
| Rate for Payer: First Health Commercial |
$1,321.20
|
| Rate for Payer: First Health Workers Compensation |
$566.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,321.20
|
| Rate for Payer: GEHA Commercial |
$1,027.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,321.20
|
| Rate for Payer: Multiplan All |
$1,335.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,027.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,321.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,394.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,365.24
|
| Rate for Payer: Zelis Auto |
$587.20
|
| Rate for Payer: Zelis Worker's Compensation |
$400.76
|
|
|
INCISION OF BILE DUCT
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
CPT 47425
|
| Hospital Charge Code |
6147425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.75 |
| Max. Negotiated Rate |
$2,704.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,708.20
|
| Rate for Payer: Cigna Commercial |
$2,419.95
|
| Rate for Payer: First Health Commercial |
$2,562.30
|
| Rate for Payer: First Health Workers Compensation |
$1,099.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,562.30
|
| Rate for Payer: GEHA Commercial |
$2,277.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,562.30
|
| Rate for Payer: Humana ChoiceCare |
$740.22
|
| Rate for Payer: Multiplan All |
$2,590.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,708.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,992.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,562.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,704.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,135.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,505.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$711.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,647.71
|
| Rate for Payer: Zelis Auto |
$1,138.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,423.50
|
| Rate for Payer: Zelis Worker's Compensation |
$777.23
|
|
|
INCISION OF BILE DUCT
|
Facility
|
IP
|
$2,822.00
|
|
|
Service Code
|
CPT 47420
|
| Hospital Charge Code |
6147420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$770.41 |
| Max. Negotiated Rate |
$2,680.90 |
| Rate for Payer: Cash Price |
$1,693.20
|
| Rate for Payer: Cigna Commercial |
$2,398.70
|
| Rate for Payer: First Health Commercial |
$2,539.80
|
| Rate for Payer: First Health Workers Compensation |
$1,089.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,539.80
|
| Rate for Payer: GEHA Commercial |
$1,975.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,539.80
|
| Rate for Payer: Multiplan All |
$2,568.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,975.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,539.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,680.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,116.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,624.46
|
| Rate for Payer: Zelis Auto |
$1,128.80
|
| Rate for Payer: Zelis Worker's Compensation |
$770.41
|
|
|
INCISION OF BILE DUCT
|
Facility
|
OP
|
$2,822.00
|
|
|
Service Code
|
CPT 47420
|
| Hospital Charge Code |
6147420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$705.50 |
| Max. Negotiated Rate |
$2,680.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,693.20
|
| Rate for Payer: Cash Price |
$1,693.20
|
| Rate for Payer: Cigna Commercial |
$2,398.70
|
| Rate for Payer: First Health Commercial |
$2,539.80
|
| Rate for Payer: First Health Workers Compensation |
$1,089.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,539.80
|
| Rate for Payer: GEHA Commercial |
$2,257.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,539.80
|
| Rate for Payer: Humana ChoiceCare |
$733.72
|
| Rate for Payer: Multiplan All |
$2,568.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,693.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,975.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,539.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,680.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,116.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,483.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$705.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,624.46
|
| Rate for Payer: Zelis Auto |
$1,128.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,411.00
|
| Rate for Payer: Zelis Worker's Compensation |
$770.41
|
|
|
INCISION OF BILE DUCT
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
CPT 47425
|
| Hospital Charge Code |
6147425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$777.23 |
| Max. Negotiated Rate |
$2,704.65 |
| Rate for Payer: Cash Price |
$1,708.20
|
| Rate for Payer: Cigna Commercial |
$2,419.95
|
| Rate for Payer: First Health Commercial |
$2,562.30
|
| Rate for Payer: First Health Workers Compensation |
$1,099.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,562.30
|
| Rate for Payer: GEHA Commercial |
$1,992.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,562.30
|
| Rate for Payer: Multiplan All |
$2,590.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,992.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,562.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,704.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,135.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,647.71
|
| Rate for Payer: Zelis Auto |
$1,138.80
|
| Rate for Payer: Zelis Worker's Compensation |
$777.23
|
|
|
INCISION OF BREAST LESION
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
6119020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$663.00
|
| Rate for Payer: First Health Commercial |
$702.00
|
| Rate for Payer: First Health Workers Compensation |
$301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.00
|
| Rate for Payer: GEHA Commercial |
$546.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.00
|
| Rate for Payer: Multiplan All |
$709.80
|
| Rate for Payer: OMNI Networks Commercial |
$546.00
|
| Rate for Payer: One Health Plan PPO/POS |
$702.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.00
|
| Rate for Payer: Three Rivers Provider Network All |
$585.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$725.40
|
| Rate for Payer: Zelis Auto |
$312.00
|
| Rate for Payer: Zelis Worker's Compensation |
$212.94
|
|
|
INCISION OF BREAST LESION
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
6119020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$468.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$663.00
|
| Rate for Payer: First Health Commercial |
$702.00
|
| Rate for Payer: First Health Workers Compensation |
$301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.00
|
| Rate for Payer: GEHA Commercial |
$624.00
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.00
|
| 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 |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$709.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$546.00
|
| Rate for Payer: One Health Plan PPO/POS |
$702.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$585.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$725.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$312.00
|
| 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 |
$212.94
|
|
|
INCISION OF BROW NERVE
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 64732
|
| Hospital Charge Code |
6164732
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.71 |
| 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 |
$573.00
|
| 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 |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$764.00
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| 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 |
$869.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| 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 |
$907.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| 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 |
$888.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$382.00
|
| 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 |
$260.71
|
|
|
INCISION OF BROW NERVE
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 64732
|
| Hospital Charge Code |
6164732
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$668.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$888.15
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
INCISION OF BURN SCAB INITI
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 16035
|
| Hospital Charge Code |
6116035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
INCISION OF BURN SCAB INITI
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 16035
|
| Hospital Charge Code |
6116035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$387.14
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: GEHA Medicare |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
INCISION OF CHEEK NERVE
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
CPT 64734
|
| Hospital Charge Code |
6164734
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.59 |
| Max. Negotiated Rate |
$798.95 |
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cigna Commercial |
$714.85
|
| Rate for Payer: First Health Commercial |
$756.90
|
| Rate for Payer: First Health Workers Compensation |
$324.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.90
|
| Rate for Payer: GEHA Commercial |
$588.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.90
|
| Rate for Payer: Multiplan All |
$765.31
|
| Rate for Payer: OMNI Networks Commercial |
$588.70
|
| Rate for Payer: One Health Plan PPO/POS |
$756.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.95
|
| Rate for Payer: Three Rivers Provider Network All |
$630.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$782.13
|
| Rate for Payer: Zelis Auto |
$336.40
|
| Rate for Payer: Zelis Worker's Compensation |
$229.59
|
|
|
INCISION OF CHEEK NERVE
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 64734
|
| Hospital Charge Code |
6164734
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.59 |
| 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 |
$504.60
|
| 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 |
$504.60
|
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cigna Commercial |
$714.85
|
| Rate for Payer: First Health Commercial |
$756.90
|
| Rate for Payer: First Health Workers Compensation |
$324.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.90
|
| Rate for Payer: GEHA Commercial |
$672.80
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.90
|
| 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 |
$765.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$588.70
|
| Rate for Payer: One Health Plan PPO/POS |
$756.90
|
| 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 |
$798.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$630.75
|
| 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 |
$782.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$336.40
|
| 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 |
$229.59
|
|
|
INCISION OF CHIN NERVE
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT 64736
|
| Hospital Charge Code |
6164736
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$961.40 |
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$708.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
INCISION OF CHIN NERVE
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 64736
|
| Hospital Charge Code |
6164736
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| 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 |
$607.20
|
| 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 |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$809.60
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| 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 |
$920.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| 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 |
$961.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| 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 |
$941.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$404.80
|
| 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 |
$276.28
|
|
|
INCISION OF COLLARBONE JOINT
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT 23106
|
| Hospital Charge Code |
6123106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| 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 |
$600.60
|
| 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 |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| 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 |
$910.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| 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 |
$950.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| 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 |
$930.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$400.40
|
| 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 |
$273.27
|
|
|
INCISION OF COLLARBONE JOINT
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT 23106
|
| Hospital Charge Code |
6123106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$700.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: Zelis Auto |
$400.40
|
| Rate for Payer: Zelis Worker's Compensation |
$273.27
|
|
|
INCISION OF EARDRUM
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 69421
|
| Hospital Charge Code |
6169421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.94 |
| Max. Negotiated Rate |
$431.30 |
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$385.90
|
| Rate for Payer: First Health Commercial |
$408.60
|
| Rate for Payer: First Health Workers Compensation |
$175.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$408.60
|
| Rate for Payer: GEHA Commercial |
$317.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$408.60
|
| Rate for Payer: Multiplan All |
$413.14
|
| Rate for Payer: OMNI Networks Commercial |
$317.80
|
| Rate for Payer: One Health Plan PPO/POS |
$408.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$431.30
|
| Rate for Payer: Three Rivers Provider Network All |
$340.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$422.22
|
| Rate for Payer: Zelis Auto |
$181.60
|
| Rate for Payer: Zelis Worker's Compensation |
$123.94
|
|
|
INCISION OF EARDRUM
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 69421
|
| Hospital Charge Code |
6169421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.94 |
| Max. Negotiated Rate |
$6,284.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$272.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,142.47
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$385.90
|
| Rate for Payer: First Health Commercial |
$408.60
|
| Rate for Payer: First Health Workers Compensation |
$175.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$408.60
|
| Rate for Payer: GEHA Commercial |
$363.20
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$408.60
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$413.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$317.80
|
| Rate for Payer: One Health Plan PPO/POS |
$408.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$431.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$340.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$422.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$181.60
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$123.94
|
|
