|
INCISION OF WRIST CAPSULE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 25085
|
| Hospital Charge Code |
6125085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$546.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$546.60
|
| 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 |
$728.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
23500009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
8710121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$7,693.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
1910121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,334.48 |
| Max. Negotiated Rate |
$7,308.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,615.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$4,615.80
|
| Rate for Payer: Cash Price |
$4,615.80
|
| Rate for Payer: Cigna Commercial |
$6,539.05
|
| Rate for Payer: First Health Commercial |
$6,923.70
|
| Rate for Payer: First Health Workers Compensation |
$2,970.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,923.70
|
| Rate for Payer: GEHA Commercial |
$6,154.40
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,923.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$7,000.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$5,385.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,923.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,308.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$5,769.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,154.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$3,077.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$2,100.19
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
8710121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$6,309.00
|
|
| Hospital Charge Code |
8110121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,722.36 |
| Max. Negotiated Rate |
$5,993.55 |
| Rate for Payer: Cash Price |
$3,785.40
|
| Rate for Payer: Cigna Commercial |
$5,362.65
|
| Rate for Payer: First Health Commercial |
$5,678.10
|
| Rate for Payer: First Health Workers Compensation |
$2,435.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,678.10
|
| Rate for Payer: GEHA Commercial |
$4,416.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,678.10
|
| Rate for Payer: Multiplan All |
$5,741.19
|
| Rate for Payer: OMNI Networks Commercial |
$4,416.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,678.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,993.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,731.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,867.37
|
| Rate for Payer: Zelis Auto |
$2,523.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,722.36
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
20300098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$7,693.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
1910121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,100.19 |
| Max. Negotiated Rate |
$7,308.35 |
| Rate for Payer: Cash Price |
$4,615.80
|
| Rate for Payer: Cigna Commercial |
$6,539.05
|
| Rate for Payer: First Health Commercial |
$6,923.70
|
| Rate for Payer: First Health Workers Compensation |
$2,970.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,923.70
|
| Rate for Payer: GEHA Commercial |
$5,385.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,923.70
|
| Rate for Payer: Multiplan All |
$7,000.63
|
| Rate for Payer: OMNI Networks Commercial |
$5,385.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,923.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,308.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,769.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,154.49
|
| Rate for Payer: Zelis Auto |
$3,077.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,100.19
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
6110121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$6,309.00
|
|
| Hospital Charge Code |
8110121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,577.25 |
| Max. Negotiated Rate |
$5,993.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,785.40
|
| Rate for Payer: Cash Price |
$3,785.40
|
| Rate for Payer: Cigna Commercial |
$5,362.65
|
| Rate for Payer: First Health Commercial |
$5,678.10
|
| Rate for Payer: First Health Workers Compensation |
$2,435.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,678.10
|
| Rate for Payer: GEHA Commercial |
$5,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,678.10
|
| Rate for Payer: Humana ChoiceCare |
$1,640.34
|
| Rate for Payer: Multiplan All |
$5,741.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,785.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,416.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,678.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,993.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,731.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,551.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,577.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,867.37
|
| Rate for Payer: Zelis Auto |
$2,523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,154.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,722.36
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
8300003
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
21600165
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
8300003
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$7,579.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9610121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,069.07 |
| Max. Negotiated Rate |
$7,200.05 |
| Rate for Payer: Cash Price |
$4,547.40
|
| Rate for Payer: Cigna Commercial |
$6,442.15
|
| Rate for Payer: First Health Commercial |
$6,821.10
|
| Rate for Payer: First Health Workers Compensation |
$2,926.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,821.10
|
| Rate for Payer: GEHA Commercial |
$5,305.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,821.10
|
| Rate for Payer: Multiplan All |
$6,896.89
|
| Rate for Payer: OMNI Networks Commercial |
$5,305.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,821.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,200.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,684.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,048.47
|
| Rate for Payer: Zelis Auto |
$3,031.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2,069.07
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
20300098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
21600165
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
6110121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
23500009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INCISION & REMOVAL FOREIGN BODY SQ COMPL
|
Facility
|
OP
|
$7,579.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9610121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,334.48 |
| Max. Negotiated Rate |
$7,200.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,547.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$4,547.40
|
| Rate for Payer: Cash Price |
$4,547.40
|
| Rate for Payer: Cigna Commercial |
$6,442.15
|
| Rate for Payer: First Health Commercial |
$6,821.10
|
| Rate for Payer: First Health Workers Compensation |
$2,926.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,821.10
|
| Rate for Payer: GEHA Commercial |
$6,063.20
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,821.10
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$6,896.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$5,305.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,821.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,200.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$5,684.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,048.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$3,031.60
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$2,069.07
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
21600467
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$430.35 |
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$385.05
|
| Rate for Payer: First Health Commercial |
$407.70
|
| Rate for Payer: First Health Workers Compensation |
$174.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$407.70
|
| Rate for Payer: GEHA Commercial |
$317.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: OMNI Networks Commercial |
$317.10
|
| Rate for Payer: One Health Plan PPO/POS |
$407.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
20300046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$430.35 |
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$385.05
|
| Rate for Payer: First Health Commercial |
$407.70
|
| Rate for Payer: First Health Workers Compensation |
$174.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$407.70
|
| Rate for Payer: GEHA Commercial |
$317.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: OMNI Networks Commercial |
$317.10
|
| Rate for Payer: One Health Plan PPO/POS |
$407.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
IP
|
$1,973.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9610120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$538.63 |
| Max. Negotiated Rate |
$1,874.35 |
| Rate for Payer: Cash Price |
$1,183.80
|
| Rate for Payer: Cigna Commercial |
$1,677.05
|
| Rate for Payer: First Health Commercial |
$1,775.70
|
| Rate for Payer: First Health Workers Compensation |
$761.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,775.70
|
| Rate for Payer: GEHA Commercial |
$1,381.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,775.70
|
| Rate for Payer: Multiplan All |
$1,795.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,381.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,775.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,874.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,479.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,834.89
|
| Rate for Payer: Zelis Auto |
$789.20
|
| Rate for Payer: Zelis Worker's Compensation |
$538.63
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
8710120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$387.14
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$385.05
|
| Rate for Payer: First Health Commercial |
$407.70
|
| Rate for Payer: First Health Workers Compensation |
$174.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$407.70
|
| Rate for Payer: GEHA Commercial |
$362.40
|
| Rate for Payer: GEHA Medicare |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| Rate for Payer: OMNI Networks Commercial |
$317.10
|
| Rate for Payer: One Health Plan PPO/POS |
$407.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
8710120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$430.35 |
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$385.05
|
| Rate for Payer: First Health Commercial |
$407.70
|
| Rate for Payer: First Health Workers Compensation |
$174.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$407.70
|
| Rate for Payer: GEHA Commercial |
$317.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: OMNI Networks Commercial |
$317.10
|
| Rate for Payer: One Health Plan PPO/POS |
$407.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
6110120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
