|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
6128232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$369.60
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$237.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$492.80
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$168.17
|
|
|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
6128010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.42 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$317.40
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$423.20
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$481.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$502.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
|
INCISION OF TONGUE NERVE
|
Facility
|
OP
|
$933.00
|
|
|
Service Code
|
CPT 64740
|
| Hospital Charge Code |
6164740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.71 |
| 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 |
$559.80
|
| 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 |
$1,892.20
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$746.40
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| 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 |
$849.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| 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 |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| 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 |
$867.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$373.20
|
| 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 |
$254.71
|
|
|
INCISION OF TONGUE NERVE
|
Facility
|
IP
|
$933.00
|
|
|
Service Code
|
CPT 64740
|
| Hospital Charge Code |
6164740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.71 |
| Max. Negotiated Rate |
$886.35 |
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$653.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| Rate for Payer: Multiplan All |
$849.03
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$867.69
|
| Rate for Payer: Zelis Auto |
$373.20
|
| Rate for Payer: Zelis Worker's Compensation |
$254.71
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
CPT 53010
|
| Hospital Charge Code |
6153010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$205.30 |
| Max. Negotiated Rate |
$9,851.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$451.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,925.93
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$639.20
|
| Rate for Payer: First Health Commercial |
$676.80
|
| Rate for Payer: First Health Workers Compensation |
$290.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$676.80
|
| Rate for Payer: GEHA Commercial |
$601.60
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$676.80
|
| Rate for Payer: Humana ChoiceCare |
$5,418.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,925.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,275.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,925.93
|
| Rate for Payer: Multiplan All |
$684.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$526.40
|
| Rate for Payer: One Health Plan PPO/POS |
$676.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,925.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$714.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$564.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,827.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,925.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$699.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$300.80
|
| Rate for Payer: Zelis Medicare |
$4,187.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,911.12
|
| Rate for Payer: Zelis Worker's Compensation |
$205.30
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
6153000
|
|
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 URETHRA
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
CPT 53010
|
| Hospital Charge Code |
6153010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$205.30 |
| Max. Negotiated Rate |
$714.40 |
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$639.20
|
| Rate for Payer: First Health Commercial |
$676.80
|
| Rate for Payer: First Health Workers Compensation |
$290.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$676.80
|
| Rate for Payer: GEHA Commercial |
$526.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$676.80
|
| Rate for Payer: Multiplan All |
$684.32
|
| Rate for Payer: OMNI Networks Commercial |
$526.40
|
| Rate for Payer: One Health Plan PPO/POS |
$676.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$714.40
|
| Rate for Payer: Three Rivers Provider Network All |
$564.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$699.36
|
| Rate for Payer: Zelis Auto |
$300.80
|
| Rate for Payer: Zelis Worker's Compensation |
$205.30
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
6153000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.94 |
| Max. Negotiated Rate |
$3,969.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| 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 |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| 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 |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$408.60
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$413.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| 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 |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$431.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$340.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$422.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$181.60
|
| 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 |
$123.94
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
6153020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$210.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Worker's Compensation |
$82.17
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
6153020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$3,969.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$120.40
|
| 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 |
$82.17
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 53025
|
| Hospital Charge Code |
6153025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 53025
|
| Hospital Charge Code |
6153025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$3,969.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$88.80
|
| 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 |
$60.61
|
|
|
INCISION OF VAGUS NERVE
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
CPT 64760
|
| Hospital Charge Code |
6164760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$285.83 |
| Max. Negotiated Rate |
$994.65 |
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cigna Commercial |
$889.95
|
| Rate for Payer: First Health Commercial |
$942.30
|
| Rate for Payer: First Health Workers Compensation |
$404.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$942.30
|
| Rate for Payer: GEHA Commercial |
$732.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$942.30
|
| Rate for Payer: Multiplan All |
$952.77
|
| Rate for Payer: OMNI Networks Commercial |
$732.90
|
| Rate for Payer: One Health Plan PPO/POS |
$942.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$994.65
|
| Rate for Payer: Three Rivers Provider Network All |
$785.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$973.71
|
| Rate for Payer: Zelis Auto |
$418.80
|
| Rate for Payer: Zelis Worker's Compensation |
$285.83
|
|
|
INCISION OF VAGUS NERVE
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
CPT 64760
|
| Hospital Charge Code |
6164760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.75 |
| Max. Negotiated Rate |
$994.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$628.20
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cigna Commercial |
$889.95
|
| Rate for Payer: First Health Commercial |
$942.30
|
| Rate for Payer: First Health Workers Compensation |
$404.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$942.30
|
| Rate for Payer: GEHA Commercial |
$837.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$942.30
|
| Rate for Payer: Humana ChoiceCare |
$272.22
|
| Rate for Payer: Multiplan All |
$952.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$628.20
|
| Rate for Payer: OMNI Networks Commercial |
$732.90
|
| Rate for Payer: One Health Plan PPO/POS |
$942.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$994.65
|
| Rate for Payer: Three Rivers Provider Network All |
$785.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$921.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$261.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$973.71
|
| Rate for Payer: Zelis Auto |
$418.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$523.50
|
| Rate for Payer: Zelis Worker's Compensation |
$285.83
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
6131603
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$2,870.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,435.33
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: First Health Workers Compensation |
$227.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: GEHA Medicare |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| 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 |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$235.20
|
| 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 |
$160.52
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
6131605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: First Health Workers Compensation |
$225.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$408.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
| Rate for Payer: Zelis Worker's Compensation |
$159.16
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
6131600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.96 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$709.75
|
| Rate for Payer: First Health Commercial |
$751.50
|
| Rate for Payer: First Health Workers Compensation |
$322.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.50
|
| Rate for Payer: GEHA Commercial |
$584.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.50
|
| Rate for Payer: Multiplan All |
$759.85
|
| Rate for Payer: OMNI Networks Commercial |
$584.50
|
| Rate for Payer: One Health Plan PPO/POS |
$751.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$793.25
|
| Rate for Payer: Three Rivers Provider Network All |
$626.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$776.55
|
| Rate for Payer: Zelis Auto |
$334.00
|
| Rate for Payer: Zelis Worker's Compensation |
$227.96
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 31601
|
| Hospital Charge Code |
6131601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.54 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$392.40
|
| 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 |
$5,732.16
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$252.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$523.20
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$178.54
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
6131603
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: First Health Workers Compensation |
$227.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Worker's Compensation |
$160.52
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 31601
|
| Hospital Charge Code |
6131601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.54 |
| Max. Negotiated Rate |
$621.30 |
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$252.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$457.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Worker's Compensation |
$178.54
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$1,457.00
|
|
|
Service Code
|
CPT 31610
|
| Hospital Charge Code |
6131610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$397.76 |
| Max. Negotiated Rate |
$1,384.15 |
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Cigna Commercial |
$1,238.45
|
| Rate for Payer: First Health Commercial |
$1,311.30
|
| Rate for Payer: First Health Workers Compensation |
$562.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,311.30
|
| Rate for Payer: GEHA Commercial |
$1,019.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,311.30
|
| Rate for Payer: Multiplan All |
$1,325.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,019.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,311.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,384.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,092.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.01
|
| Rate for Payer: Zelis Auto |
$582.80
|
| Rate for Payer: Zelis Worker's Compensation |
$397.76
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
6131600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.75 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$709.75
|
| Rate for Payer: First Health Commercial |
$751.50
|
| Rate for Payer: First Health Workers Compensation |
$322.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.50
|
| Rate for Payer: GEHA Commercial |
$668.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.50
|
| Rate for Payer: Humana ChoiceCare |
$217.10
|
| Rate for Payer: Multiplan All |
$759.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$501.00
|
| Rate for Payer: OMNI Networks Commercial |
$584.50
|
| Rate for Payer: One Health Plan PPO/POS |
$751.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$793.25
|
| Rate for Payer: Three Rivers Provider Network All |
$626.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$734.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$776.55
|
| Rate for Payer: Zelis Auto |
$334.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$417.50
|
| Rate for Payer: Zelis Worker's Compensation |
$227.96
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
6131605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$770.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$349.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$225.02
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: First Health Workers Compensation |
$225.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$466.40
|
| Rate for Payer: GEHA Medicare |
$225.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Humana ChoiceCare |
$247.52
|
| Rate for Payer: Humana Medicare Advantage |
$225.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$378.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$225.02
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$382.53
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$225.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$450.04
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$225.02
|
| Rate for Payer: Zelis Auto |
$233.20
|
| Rate for Payer: Zelis Medicare |
$191.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.02
|
| Rate for Payer: Zelis Worker's Compensation |
$159.16
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$1,457.00
|
|
|
Service Code
|
CPT 31610
|
| Hospital Charge Code |
6131610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$397.76 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$874.20
|
| 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 |
$5,732.16
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Cigna Commercial |
$1,238.45
|
| Rate for Payer: First Health Commercial |
$1,311.30
|
| Rate for Payer: First Health Workers Compensation |
$562.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,311.30
|
| Rate for Payer: GEHA Commercial |
$1,165.60
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,311.30
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,325.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,019.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,311.30
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,384.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,092.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$582.80
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$397.76
|
|
|
INCISION OF WRIST CAPSULE
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 25085
|
| Hospital Charge Code |
6125085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
