|
INCISION OF METATARSAL
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 28306
|
| Hospital Charge Code |
6128306
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$495.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$702.10
|
| Rate for Payer: First Health Commercial |
$743.40
|
| Rate for Payer: First Health Workers Compensation |
$318.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$743.40
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$743.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$751.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$578.20
|
| Rate for Payer: One Health Plan PPO/POS |
$743.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$784.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$619.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$768.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$330.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$225.50
|
|
|
INCISION OF METATARSAL
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 28307
|
| Hospital Charge Code |
6128307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.43 |
| Max. Negotiated Rate |
$874.95 |
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna Commercial |
$782.85
|
| Rate for Payer: First Health Commercial |
$828.90
|
| Rate for Payer: First Health Workers Compensation |
$355.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.90
|
| Rate for Payer: GEHA Commercial |
$644.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.90
|
| Rate for Payer: Multiplan All |
$838.11
|
| Rate for Payer: OMNI Networks Commercial |
$644.70
|
| Rate for Payer: One Health Plan PPO/POS |
$828.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.95
|
| Rate for Payer: Three Rivers Provider Network All |
$690.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$856.53
|
| Rate for Payer: Zelis Auto |
$368.40
|
| Rate for Payer: Zelis Worker's Compensation |
$251.43
|
|
|
INCISION OF METATARSAL
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 28307
|
| Hospital Charge Code |
6128307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.43 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$552.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna Commercial |
$782.85
|
| Rate for Payer: First Health Commercial |
$828.90
|
| Rate for Payer: First Health Workers Compensation |
$355.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.90
|
| Rate for Payer: GEHA Commercial |
$736.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.90
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$838.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$644.70
|
| Rate for Payer: One Health Plan PPO/POS |
$828.90
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$690.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$856.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$368.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$251.43
|
|
|
INCISION OF METATARSAL
|
Facility
|
OP
|
$1,850.43
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
6128308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$505.17 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$1,110.26
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,110.26
|
| Rate for Payer: Cash Price |
$1,110.26
|
| Rate for Payer: Cigna Commercial |
$1,572.87
|
| Rate for Payer: First Health Commercial |
$1,665.39
|
| Rate for Payer: First Health Workers Compensation |
$714.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,665.39
|
| Rate for Payer: GEHA Commercial |
$1,480.34
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,665.39
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,683.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,295.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,665.39
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,757.91
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,387.82
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,720.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$740.17
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$505.17
|
|
|
INCISION OF METATARSALS
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
CPT 28309
|
| Hospital Charge Code |
6128309
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$508.87 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cigna Commercial |
$1,584.40
|
| Rate for Payer: First Health Commercial |
$1,677.60
|
| Rate for Payer: First Health Workers Compensation |
$719.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,677.60
|
| Rate for Payer: GEHA Commercial |
$1,491.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,677.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,696.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,304.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,677.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,770.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,398.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,733.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$745.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$508.87
|
|
|
INCISION OF METATARSALS
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
CPT 28309
|
| Hospital Charge Code |
6128309
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$508.87 |
| Max. Negotiated Rate |
$1,770.80 |
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cigna Commercial |
$1,584.40
|
| Rate for Payer: First Health Commercial |
$1,677.60
|
| Rate for Payer: First Health Workers Compensation |
$719.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,677.60
|
| Rate for Payer: GEHA Commercial |
$1,304.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,677.60
|
| Rate for Payer: Multiplan All |
$1,696.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,304.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,677.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,770.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,398.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,733.52
|
| Rate for Payer: Zelis Auto |
$745.60
|
| Rate for Payer: Zelis Worker's Compensation |
$508.87
|
|
|
INCISION OF MIDFOOT BONES
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 28304
|
| Hospital Charge Code |
6128304
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$746.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$995.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
INCISION OF MIDFOOT BONES
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 28304
|
| Hospital Charge Code |
6128304
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$870.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
INCISION OF NECK OF FEMUR
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 27161
|
| Hospital Charge Code |
6127161
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$626.50 |
| Max. Negotiated Rate |
$2,380.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,503.60
|
| Rate for Payer: Cash Price |
$1,503.60
|
| Rate for Payer: Cigna Commercial |
$2,130.10
|
| Rate for Payer: First Health Commercial |
$2,255.40
|
| Rate for Payer: First Health Workers Compensation |
$967.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,255.40
|
| Rate for Payer: GEHA Commercial |
$2,004.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,255.40
|
| Rate for Payer: Humana ChoiceCare |
$651.56
|
| Rate for Payer: Multiplan All |
$2,280.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,503.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,754.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,255.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,380.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,879.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,205.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$626.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,330.58
|
| Rate for Payer: Zelis Auto |
$1,002.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,253.00
|
| Rate for Payer: Zelis Worker's Compensation |
$684.14
|
|
|
INCISION OF NECK OF FEMUR
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 27161
|
| Hospital Charge Code |
6127161
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$684.14 |
| Max. Negotiated Rate |
$2,380.70 |
| Rate for Payer: Cash Price |
$1,503.60
|
| Rate for Payer: Cigna Commercial |
$2,130.10
|
| Rate for Payer: First Health Commercial |
$2,255.40
|
| Rate for Payer: First Health Workers Compensation |
$967.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,255.40
|
| Rate for Payer: GEHA Commercial |
$1,754.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,255.40
|
| Rate for Payer: Multiplan All |
$2,280.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,754.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,255.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,380.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,879.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,330.58
|
| Rate for Payer: Zelis Auto |
$1,002.40
|
| Rate for Payer: Zelis Worker's Compensation |
$684.14
|
|
|
INCISION OF PALM TENDON
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 26450
|
| Hospital Charge Code |
6126450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$601.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$802.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
INCISION OF PALM TENDON
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 26450
|
| Hospital Charge Code |
6126450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$702.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
INCISION OF PROSTATE
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 52450
|
| Hospital Charge Code |
6152450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.90 |
| Max. Negotiated Rate |
$914.85 |
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$674.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| Rate for Payer: Multiplan All |
$876.33
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$914.85
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$895.59
|
| Rate for Payer: Zelis Auto |
$385.20
|
| Rate for Payer: Zelis Worker's Compensation |
$262.90
|
|
|
INCISION OF PROSTATE
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 52450
|
| Hospital Charge Code |
6152450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.90 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$577.80
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$770.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$876.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$914.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$895.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$385.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$262.90
|
|
|
INCISION OF PYLORIC MUSCLE
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 43520
|
| Hospital Charge Code |
6143520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$394.49 |
| Max. Negotiated Rate |
$1,372.75 |
| Rate for Payer: Cash Price |
$867.00
|
| Rate for Payer: Cigna Commercial |
$1,228.25
|
| Rate for Payer: First Health Commercial |
$1,300.50
|
| Rate for Payer: First Health Workers Compensation |
$557.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,300.50
|
| Rate for Payer: GEHA Commercial |
$1,011.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,300.50
|
| Rate for Payer: Multiplan All |
$1,314.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,011.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,300.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,372.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,083.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,343.85
|
| Rate for Payer: Zelis Auto |
$578.00
|
| Rate for Payer: Zelis Worker's Compensation |
$394.49
|
|
|
INCISION OF PYLORIC MUSCLE
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 43520
|
| Hospital Charge Code |
6143520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$361.25 |
| Max. Negotiated Rate |
$1,372.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$867.00
|
| Rate for Payer: Cash Price |
$867.00
|
| Rate for Payer: Cigna Commercial |
$1,228.25
|
| Rate for Payer: First Health Commercial |
$1,300.50
|
| Rate for Payer: First Health Workers Compensation |
$557.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,300.50
|
| Rate for Payer: GEHA Commercial |
$1,156.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,300.50
|
| Rate for Payer: Humana ChoiceCare |
$375.70
|
| Rate for Payer: Multiplan All |
$1,314.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$867.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,011.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,300.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,372.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,083.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,271.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$361.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,343.85
|
| Rate for Payer: Zelis Auto |
$578.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$722.50
|
| Rate for Payer: Zelis Worker's Compensation |
$394.49
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 46045
|
| Hospital Charge Code |
6146045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$624.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| Rate for Payer: Multiplan All |
$811.72
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$847.40
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$829.56
|
| Rate for Payer: Zelis Auto |
$356.80
|
| Rate for Payer: Zelis Worker's Compensation |
$243.52
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 46060
|
| Hospital Charge Code |
6146060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.72 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$586.20
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$781.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$266.72
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 46045
|
| Hospital Charge Code |
6146045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$535.20
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$713.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$811.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$847.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$829.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$356.80
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$243.52
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
CPT 46060
|
| Hospital Charge Code |
6146060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.72 |
| Max. Negotiated Rate |
$928.15 |
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$683.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Worker's Compensation |
$266.72
|
|
|
INCISION OF SPERM DUCT
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 55200
|
| Hospital Charge Code |
6155200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$428.40
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$606.90
|
| Rate for Payer: First Health Commercial |
$642.60
|
| Rate for Payer: First Health Workers Compensation |
$275.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$642.60
|
| Rate for Payer: GEHA Commercial |
$571.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$642.60
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$649.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$499.80
|
| Rate for Payer: One Health Plan PPO/POS |
$642.60
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$678.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$535.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$285.60
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$194.92
|
|
|
INCISION OF SPERM DUCT
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 55200
|
| Hospital Charge Code |
6155200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$606.90
|
| Rate for Payer: First Health Commercial |
$642.60
|
| Rate for Payer: First Health Workers Compensation |
$275.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$642.60
|
| Rate for Payer: GEHA Commercial |
$499.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$642.60
|
| Rate for Payer: Multiplan All |
$649.74
|
| Rate for Payer: OMNI Networks Commercial |
$499.80
|
| Rate for Payer: One Health Plan PPO/POS |
$642.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$678.30
|
| Rate for Payer: Three Rivers Provider Network All |
$535.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.02
|
| Rate for Payer: Zelis Auto |
$285.60
|
| Rate for Payer: Zelis Worker's Compensation |
$194.92
|
|
|
INCISION OF SPINAL NERVE
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 64772
|
| Hospital Charge Code |
6164772
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.77 |
| Max. Negotiated Rate |
$3,708.46 |
| 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 |
$691.80
|
| 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 |
$1,854.23
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cigna Commercial |
$980.05
|
| Rate for Payer: First Health Commercial |
$1,037.70
|
| Rate for Payer: First Health Workers Compensation |
$445.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,037.70
|
| Rate for Payer: GEHA Commercial |
$922.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,037.70
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,049.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$807.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,037.70
|
| 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 |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,095.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$864.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,072.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$461.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$314.77
|
|
|
INCISION OF SPINAL NERVE
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 64772
|
| Hospital Charge Code |
6164772
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.77 |
| Max. Negotiated Rate |
$1,095.35 |
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cigna Commercial |
$980.05
|
| Rate for Payer: First Health Commercial |
$1,037.70
|
| Rate for Payer: First Health Workers Compensation |
$445.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,037.70
|
| Rate for Payer: GEHA Commercial |
$807.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,037.70
|
| Rate for Payer: Multiplan All |
$1,049.23
|
| Rate for Payer: OMNI Networks Commercial |
$807.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,037.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,095.35
|
| Rate for Payer: Three Rivers Provider Network All |
$864.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,072.29
|
| Rate for Payer: Zelis Auto |
$461.20
|
| Rate for Payer: Zelis Worker's Compensation |
$314.77
|
|
|
INCISION OF STOMACH NERVES
|
Facility
|
OP
|
$1,936.00
|
|
|
Service Code
|
CPT 64755
|
| Hospital Charge Code |
6164755
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$1,839.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,161.60
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cigna Commercial |
$1,645.60
|
| Rate for Payer: First Health Commercial |
$1,742.40
|
| Rate for Payer: First Health Workers Compensation |
$747.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,742.40
|
| Rate for Payer: GEHA Commercial |
$1,548.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,742.40
|
| Rate for Payer: Humana ChoiceCare |
$503.36
|
| Rate for Payer: Multiplan All |
$1,761.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,161.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,355.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,742.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,839.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,452.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,703.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$484.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,800.48
|
| Rate for Payer: Zelis Auto |
$774.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$968.00
|
| Rate for Payer: Zelis Worker's Compensation |
$528.53
|
|
