|
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
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
21600467
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$379.37
|
| 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 |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
1910120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$1,902.85 |
| 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 |
$1,201.80
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$1,201.80
|
| Rate for Payer: Cash Price |
$1,201.80
|
| Rate for Payer: Cigna Commercial |
$1,702.55
|
| Rate for Payer: First Health Commercial |
$1,802.70
|
| Rate for Payer: First Health Workers Compensation |
$773.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,802.70
|
| Rate for Payer: GEHA Commercial |
$1,602.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,802.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,822.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,402.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,802.70
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,902.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,502.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,862.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$801.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$546.82
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
OP
|
$1,973.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9610120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$1,874.35 |
| 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 |
$1,183.80
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$1,183.80
|
| 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 |
$1,578.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,775.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,795.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,381.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,775.70
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,874.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,479.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,834.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$789.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$538.63
|
|
|
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
|
$315.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
6110120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$189.00
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$189.00
|
| 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 |
$252.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
INCISION & REMVAL FOREIGN BODY SQ SIMPLE
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
8300002
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$379.37
|
| 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 |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| 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 |
8300002
|
|
Hospital Revenue Code
|
519
|
| 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
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
8710120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$379.37
|
| 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 |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
6146083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
21600221
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Facility
|
OP
|
$1,705.00
|
|
| Hospital Charge Code |
8150070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$426.25 |
| Max. Negotiated Rate |
$1,619.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,023.00
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cigna Commercial |
$1,449.25
|
| Rate for Payer: First Health Commercial |
$1,534.50
|
| Rate for Payer: First Health Workers Compensation |
$658.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,534.50
|
| Rate for Payer: GEHA Commercial |
$1,364.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,534.50
|
| Rate for Payer: Humana ChoiceCare |
$443.30
|
| Rate for Payer: Multiplan All |
$1,551.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,023.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,193.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,534.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,619.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,278.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,500.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$426.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,585.65
|
| Rate for Payer: Zelis Auto |
$682.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$852.50
|
| Rate for Payer: Zelis Worker's Compensation |
$465.46
|
|
|
INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
6146083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Facility
|
IP
|
$1,705.00
|
|
| Hospital Charge Code |
8150070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$465.46 |
| Max. Negotiated Rate |
$1,619.75 |
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cigna Commercial |
$1,449.25
|
| Rate for Payer: First Health Commercial |
$1,534.50
|
| Rate for Payer: First Health Workers Compensation |
$658.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,534.50
|
| Rate for Payer: GEHA Commercial |
$1,193.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,534.50
|
| Rate for Payer: Multiplan All |
$1,551.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,193.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,534.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,619.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,278.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,585.65
|
| Rate for Payer: Zelis Auto |
$682.00
|
| Rate for Payer: Zelis Worker's Compensation |
$465.46
|
|
|
INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
21600221
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
INCLISIRAN 284 MG/1.5 ML INJ
|
Facility
|
OP
|
$10,718.06
|
|
|
Service Code
|
CPT J1306
|
| Hospital Charge Code |
3303191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$10,182.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,430.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$6,430.84
|
| Rate for Payer: Cash Price |
$6,430.84
|
| Rate for Payer: Cigna Commercial |
$9,110.35
|
| Rate for Payer: First Health Commercial |
$9,646.25
|
| Rate for Payer: First Health Workers Compensation |
$4,138.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,646.25
|
| Rate for Payer: GEHA Commercial |
$13.55
|
| Rate for Payer: GEHA Medicare |
$12.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,646.25
|
| Rate for Payer: Humana ChoiceCare |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.32
|
| Rate for Payer: Multiplan All |
$9,753.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.94
|
| Rate for Payer: OMNI Networks Commercial |
$7,502.64
|
| Rate for Payer: One Health Plan PPO/POS |
$9,646.25
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,182.16
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.64
|
| Rate for Payer: Three Rivers Provider Network All |
$8,038.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,967.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.32
|
| Rate for Payer: Zelis Auto |
$4,287.22
|
| Rate for Payer: Zelis Medicare |
$10.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.78
|
| Rate for Payer: Zelis Worker's Compensation |
$2,926.03
|
|
|
INCLISIRAN 284 MG/1.5 ML INJ
|
Facility
|
IP
|
$10,718.06
|
|
|
Service Code
|
CPT J1306
|
| Hospital Charge Code |
3303191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,926.03 |
| Max. Negotiated Rate |
$10,182.16 |
| Rate for Payer: Cash Price |
$6,430.84
|
| Rate for Payer: Cigna Commercial |
$9,110.35
|
| Rate for Payer: First Health Commercial |
$9,646.25
|
| Rate for Payer: First Health Workers Compensation |
$4,138.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,646.25
|
| Rate for Payer: GEHA Commercial |
$7,502.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,646.25
|
| Rate for Payer: Multiplan All |
$9,753.43
|
| Rate for Payer: OMNI Networks Commercial |
$7,502.64
|
| Rate for Payer: One Health Plan PPO/POS |
$9,646.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,182.16
|
| Rate for Payer: Three Rivers Provider Network All |
$8,038.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,967.80
|
| Rate for Payer: Zelis Auto |
$4,287.22
|
| Rate for Payer: Zelis Worker's Compensation |
$2,926.03
|
|
|
INDIGOTINDISULFONATE SODIUM 40MG/5ML
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3303245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$1,071.00
|
| Rate for Payer: First Health Commercial |
$1,134.00
|
| Rate for Payer: First Health Workers Compensation |
$486.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.00
|
| Rate for Payer: GEHA Commercial |
$882.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.00
|
| Rate for Payer: Multiplan All |
$1,146.60
|
| Rate for Payer: OMNI Networks Commercial |
$882.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,197.00
|
| Rate for Payer: Three Rivers Provider Network All |
$945.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,171.80
|
| Rate for Payer: Zelis Auto |
$504.00
|
| Rate for Payer: Zelis Worker's Compensation |
$343.98
|
|
|
INDIGOTINDISULFONATE SODIUM 40MG/5ML
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3303245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$1,071.00
|
| Rate for Payer: First Health Commercial |
$1,134.00
|
| Rate for Payer: First Health Workers Compensation |
$486.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.00
|
| Rate for Payer: GEHA Commercial |
$1,008.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.00
|
| Rate for Payer: Humana ChoiceCare |
$327.60
|
| Rate for Payer: Multiplan All |
$1,146.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$756.00
|
| Rate for Payer: OMNI Networks Commercial |
$882.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,197.00
|
| Rate for Payer: Three Rivers Provider Network All |
$945.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,108.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,171.80
|
| Rate for Payer: Zelis Auto |
$504.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$630.00
|
| Rate for Payer: Zelis Worker's Compensation |
$343.98
|
|
|
INDIGOTINDISULFONATE SODIUM INJ 8MG/ML
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00517037505
|
| Hospital Charge Code |
3300448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INDIGOTINDISULFONATE SODIUM INJ 8MG/ML
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00517037505
|
| Hospital Charge Code |
3300448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 15-2
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 99339
|
| Hospital Charge Code |
8599339
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 15-2
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 99339
|
| Hospital Charge Code |
8599339
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 M
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 99340
|
| Hospital Charge Code |
8599340
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: First Health Workers Compensation |
$127.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$264.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Humana ChoiceCare |
$85.80
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$198.00
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$290.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: Zelis Auto |
$132.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$165.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.09
|
|
