|
MANIPULATION OF SPINE
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 22505
|
| Hospital Charge Code |
6122505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.11 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$237.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$336.60
|
| Rate for Payer: First Health Commercial |
$356.40
|
| Rate for Payer: First Health Workers Compensation |
$152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$356.40
|
| Rate for Payer: GEHA Commercial |
$316.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$356.40
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$360.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$277.20
|
| Rate for Payer: One Health Plan PPO/POS |
$356.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$376.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$297.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$368.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$158.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$108.11
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
6126341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.97 |
| Max. Negotiated Rate |
$514.37 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$407.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: First Health Workers Compensation |
$87.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$415.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$480.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$415.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$415.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$61.97
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
6126341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.97 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: First Health Workers Compensation |
$87.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$158.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Worker's Compensation |
$61.97
|
|
|
MANNITOL 20% PREMIX IV 500 mL
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT J2150
|
| Hospital Charge Code |
3302825
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
MANNITOL 20% PREMIX IV 500 mL
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT J2150
|
| Hospital Charge Code |
3302825
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$39.52
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$91.20
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$76.00
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
MANOMETRY
|
Facility
|
IP
|
$1,421.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
6180013
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$387.93 |
| Max. Negotiated Rate |
$1,349.95 |
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cigna Commercial |
$1,207.85
|
| Rate for Payer: First Health Commercial |
$1,278.90
|
| Rate for Payer: First Health Workers Compensation |
$548.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.90
|
| Rate for Payer: GEHA Commercial |
$994.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.90
|
| Rate for Payer: Multiplan All |
$1,293.11
|
| Rate for Payer: OMNI Networks Commercial |
$994.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,321.53
|
| Rate for Payer: Zelis Auto |
$568.40
|
| Rate for Payer: Zelis Worker's Compensation |
$387.93
|
|
|
MANOMETRY
|
Facility
|
OP
|
$1,421.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
6180013
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$167.69 |
| Max. Negotiated Rate |
$1,349.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$852.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$167.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cigna Commercial |
$1,207.85
|
| Rate for Payer: First Health Commercial |
$1,278.90
|
| Rate for Payer: First Health Workers Compensation |
$548.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.90
|
| Rate for Payer: GEHA Commercial |
$1,136.80
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.90
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,293.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$994.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$197.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,321.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$568.40
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$387.93
|
|
|
MANUAL DIFF ADD ON
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
2205007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$5.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.96
|
|
|
MANUAL DIFF ADD ON
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
2205007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$5.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$3.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$4.18
|
| Rate for Payer: Humana Medicare Advantage |
$3.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.80
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.46
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.72
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.80
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$3.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.56
|
| Rate for Payer: Zelis Worker's Compensation |
$3.96
|
|
|
MANUAL PREP AND INSERTION DEEP DRUG DELI
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 20700
|
| Hospital Charge Code |
6120700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.53 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$222.70
|
| Rate for Payer: First Health Commercial |
$235.80
|
| Rate for Payer: First Health Workers Compensation |
$101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$235.80
|
| Rate for Payer: GEHA Commercial |
$183.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$235.80
|
| Rate for Payer: Multiplan All |
$238.42
|
| Rate for Payer: OMNI Networks Commercial |
$183.40
|
| Rate for Payer: One Health Plan PPO/POS |
$235.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$248.90
|
| Rate for Payer: Three Rivers Provider Network All |
$196.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$243.66
|
| Rate for Payer: Zelis Auto |
$104.80
|
| Rate for Payer: Zelis Worker's Compensation |
$71.53
|
|
|
MANUAL PREP AND INSERTION DEEP DRUG DELI
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 20700
|
| Hospital Charge Code |
6120700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$222.70
|
| Rate for Payer: First Health Commercial |
$235.80
|
| Rate for Payer: First Health Workers Compensation |
$101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$235.80
|
| Rate for Payer: GEHA Commercial |
$209.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$235.80
|
| Rate for Payer: Humana ChoiceCare |
$68.12
|
| Rate for Payer: Multiplan All |
$238.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.20
|
| Rate for Payer: OMNI Networks Commercial |
$183.40
|
| Rate for Payer: One Health Plan PPO/POS |
$235.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$248.90
|
| Rate for Payer: Three Rivers Provider Network All |
$196.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$230.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$243.66
|
| Rate for Payer: Zelis Auto |
$104.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.00
|
| Rate for Payer: Zelis Worker's Compensation |
$71.53
|
|
|
maple box elder IgE REF602489
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
maple box elder IgE REF602489
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
MARATHON LIQUID SKIN
|
Facility
|
OP
|
$393.00
|
|
| Hospital Charge Code |
90030901
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$314.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Humana ChoiceCare |
$102.18
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$235.80
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$345.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$196.50
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
MARATHON LIQUID SKIN
|
Facility
|
IP
|
$393.00
|
|
| Hospital Charge Code |
90030901
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
MAST MOD RAD
|
Facility
|
IP
|
$2,489.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
6119307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$679.50 |
| Max. Negotiated Rate |
$2,364.55 |
| Rate for Payer: Cash Price |
$1,493.40
|
| Rate for Payer: Cigna Commercial |
$2,115.65
|
| Rate for Payer: First Health Commercial |
$2,240.10
|
| Rate for Payer: First Health Workers Compensation |
$961.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,240.10
|
| Rate for Payer: GEHA Commercial |
$1,742.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,240.10
|
| Rate for Payer: Multiplan All |
$2,264.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,742.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,240.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,364.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,866.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,314.77
|
| Rate for Payer: Zelis Auto |
$995.60
|
| Rate for Payer: Zelis Worker's Compensation |
$679.50
|
|
|
MAST MOD RAD
|
Facility
|
OP
|
$2,489.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
6119307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$679.50 |
| Max. Negotiated Rate |
$12,384.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,246.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,493.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,246.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,364.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,192.39
|
| Rate for Payer: Cash Price |
$1,493.40
|
| Rate for Payer: Cash Price |
$1,493.40
|
| Rate for Payer: Cigna Commercial |
$2,115.65
|
| Rate for Payer: First Health Commercial |
$2,240.10
|
| Rate for Payer: First Health Workers Compensation |
$961.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,240.10
|
| Rate for Payer: GEHA Commercial |
$1,991.20
|
| Rate for Payer: GEHA Medicare |
$6,192.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,240.10
|
| Rate for Payer: Humana ChoiceCare |
$6,811.63
|
| Rate for Payer: Humana Medicare Advantage |
$6,192.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,403.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,432.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,192.39
|
| Rate for Payer: Multiplan All |
$2,264.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,527.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,742.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,240.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,963.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,432.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,192.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,364.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,384.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,866.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,068.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,432.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,192.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,314.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,192.39
|
| Rate for Payer: Zelis Auto |
$995.60
|
| Rate for Payer: Zelis Medicare |
$5,263.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,430.87
|
| Rate for Payer: Zelis Worker's Compensation |
$679.50
|
|
|
MASTOIDECTOMY
|
Facility
|
OP
|
$1,494.00
|
|
|
Service Code
|
CPT 69501
|
| Hospital Charge Code |
6169501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.86 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$896.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$896.40
|
| Rate for Payer: Cash Price |
$896.40
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,344.60
|
| Rate for Payer: First Health Workers Compensation |
$576.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,344.60
|
| Rate for Payer: GEHA Commercial |
$1,195.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,344.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,359.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,045.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,344.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,419.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,120.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,389.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$597.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$407.86
|
|
|
MASTOIDECTOMY
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
CPT 69502
|
| Hospital Charge Code |
6169502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$541.63 |
| Max. Negotiated Rate |
$11,234.32 |
| 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 |
$1,190.40
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cigna Commercial |
$1,686.40
|
| Rate for Payer: First Health Commercial |
$1,785.60
|
| Rate for Payer: First Health Workers Compensation |
$766.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,785.60
|
| Rate for Payer: GEHA Commercial |
$1,587.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,785.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,805.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,388.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,785.60
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,884.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,488.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,845.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$793.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$541.63
|
|
|
MASTOIDECTOMY
|
Facility
|
IP
|
$1,494.00
|
|
|
Service Code
|
CPT 69501
|
| Hospital Charge Code |
6169501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.86 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Cash Price |
$896.40
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,344.60
|
| Rate for Payer: First Health Workers Compensation |
$576.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,344.60
|
| Rate for Payer: GEHA Commercial |
$1,045.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,344.60
|
| Rate for Payer: Multiplan All |
$1,359.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,045.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,344.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,419.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,120.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,389.42
|
| Rate for Payer: Zelis Auto |
$597.60
|
| Rate for Payer: Zelis Worker's Compensation |
$407.86
|
|
|
MASTOIDECTOMY
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
CPT 69502
|
| Hospital Charge Code |
6169502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$541.63 |
| Max. Negotiated Rate |
$1,884.80 |
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cigna Commercial |
$1,686.40
|
| Rate for Payer: First Health Commercial |
$1,785.60
|
| Rate for Payer: First Health Workers Compensation |
$766.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,785.60
|
| Rate for Payer: GEHA Commercial |
$1,388.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,785.60
|
| Rate for Payer: Multiplan All |
$1,805.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,388.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,785.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,884.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,488.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,845.12
|
| Rate for Payer: Zelis Auto |
$793.60
|
| Rate for Payer: Zelis Worker's Compensation |
$541.63
|
|
|
MASTOID SURGERY REVISION
|
Facility
|
IP
|
$2,268.00
|
|
|
Service Code
|
CPT 69604
|
| Hospital Charge Code |
6169604
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$619.16 |
| Max. Negotiated Rate |
$2,154.60 |
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cigna Commercial |
$1,927.80
|
| Rate for Payer: First Health Commercial |
$2,041.20
|
| Rate for Payer: First Health Workers Compensation |
$875.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,041.20
|
| Rate for Payer: GEHA Commercial |
$1,587.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,041.20
|
| Rate for Payer: Multiplan All |
$2,063.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,587.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,041.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,154.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,701.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,109.24
|
| Rate for Payer: Zelis Auto |
$907.20
|
| Rate for Payer: Zelis Worker's Compensation |
$619.16
|
|
|
MASTOID SURGERY REVISION
|
Facility
|
IP
|
$2,217.00
|
|
|
Service Code
|
CPT 69602
|
| Hospital Charge Code |
6169602
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$605.24 |
| Max. Negotiated Rate |
$2,106.15 |
| Rate for Payer: Cash Price |
$1,330.20
|
| Rate for Payer: Cigna Commercial |
$1,884.45
|
| Rate for Payer: First Health Commercial |
$1,995.30
|
| Rate for Payer: First Health Workers Compensation |
$855.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,995.30
|
| Rate for Payer: GEHA Commercial |
$1,551.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,995.30
|
| Rate for Payer: Multiplan All |
$2,017.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,551.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,995.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,106.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,662.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,061.81
|
| Rate for Payer: Zelis Auto |
$886.80
|
| Rate for Payer: Zelis Worker's Compensation |
$605.24
|
|
|
MASTOID SURGERY REVISION
|
Facility
|
OP
|
$2,217.00
|
|
|
Service Code
|
CPT 69602
|
| Hospital Charge Code |
6169602
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$605.24 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,330.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,330.20
|
| Rate for Payer: Cash Price |
$1,330.20
|
| Rate for Payer: Cigna Commercial |
$1,884.45
|
| Rate for Payer: First Health Commercial |
$1,995.30
|
| Rate for Payer: First Health Workers Compensation |
$855.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,995.30
|
| Rate for Payer: GEHA Commercial |
$1,773.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,995.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,017.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,551.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,995.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,106.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,662.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,061.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$886.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$605.24
|
|
|
MASTOID SURGERY REVISION
|
Facility
|
IP
|
$2,134.00
|
|
|
Service Code
|
CPT 69601
|
| Hospital Charge Code |
6169601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.58 |
| Max. Negotiated Rate |
$2,027.30 |
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cigna Commercial |
$1,813.90
|
| Rate for Payer: First Health Commercial |
$1,920.60
|
| Rate for Payer: First Health Workers Compensation |
$823.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,920.60
|
| Rate for Payer: GEHA Commercial |
$1,493.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,920.60
|
| Rate for Payer: Multiplan All |
$1,941.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,493.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,920.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,027.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,600.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,984.62
|
| Rate for Payer: Zelis Auto |
$853.60
|
| Rate for Payer: Zelis Worker's Compensation |
$582.58
|
|
