|
PARING/CUTTNG B9 HYPERKERATOTIC LESION 1
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9611055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$369.75
|
| Rate for Payer: First Health Commercial |
$391.50
|
| Rate for Payer: First Health Workers Compensation |
$167.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$391.50
|
| Rate for Payer: GEHA Commercial |
$348.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$391.50
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$395.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$304.50
|
| Rate for Payer: One Health Plan PPO/POS |
$391.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$413.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$326.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$404.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$174.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$118.75
|
|
|
PARING/CUTTNG B9 HYPERKERATOTIC LESION 1
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
20300031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
PARING/CUTTNG B9 HYPERKERATOTIC LESION 1
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
20300031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
PARING/CUTTNG B9 HYPERKERATOTIC LESION 1
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
1900031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
PAROTID DUCT DIVERSION
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 42509
|
| Hospital Charge Code |
6142509
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.57 |
| Max. Negotiated Rate |
$1,654.90 |
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cigna Commercial |
$1,480.70
|
| Rate for Payer: First Health Commercial |
$1,567.80
|
| Rate for Payer: First Health Workers Compensation |
$672.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,567.80
|
| Rate for Payer: GEHA Commercial |
$1,219.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,567.80
|
| Rate for Payer: Multiplan All |
$1,585.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,219.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,567.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,654.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,306.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,620.06
|
| Rate for Payer: Zelis Auto |
$696.80
|
| Rate for Payer: Zelis Worker's Compensation |
$475.57
|
|
|
PAROTID DUCT DIVERSION
|
Facility
|
IP
|
$1,058.00
|
|
|
Service Code
|
CPT 42507
|
| Hospital Charge Code |
6142507
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$1,005.10 |
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$899.30
|
| Rate for Payer: First Health Commercial |
$952.20
|
| Rate for Payer: First Health Workers Compensation |
$408.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$952.20
|
| Rate for Payer: GEHA Commercial |
$740.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$952.20
|
| Rate for Payer: Multiplan All |
$962.78
|
| Rate for Payer: OMNI Networks Commercial |
$740.60
|
| Rate for Payer: One Health Plan PPO/POS |
$952.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,005.10
|
| Rate for Payer: Three Rivers Provider Network All |
$793.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$983.94
|
| Rate for Payer: Zelis Auto |
$423.20
|
| Rate for Payer: Zelis Worker's Compensation |
$288.83
|
|
|
PAROTID DUCT DIVERSION
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
CPT 42509
|
| Hospital Charge Code |
6142509
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.57 |
| 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 |
$1,045.20
|
| 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 |
$1,045.20
|
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cigna Commercial |
$1,480.70
|
| Rate for Payer: First Health Commercial |
$1,567.80
|
| Rate for Payer: First Health Workers Compensation |
$672.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,567.80
|
| Rate for Payer: GEHA Commercial |
$1,393.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,567.80
|
| 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 |
$1,585.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,219.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,567.80
|
| 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 |
$1,654.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,306.50
|
| 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 |
$1,620.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$696.80
|
| 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 |
$475.57
|
|
|
PAROTID DUCT DIVERSION
|
Facility
|
OP
|
$1,323.00
|
|
|
Service Code
|
CPT 42510
|
| Hospital Charge Code |
6142510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$361.18 |
| Max. Negotiated Rate |
$6,158.84 |
| 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 |
$793.80
|
| 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 |
$3,079.42
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna Commercial |
$1,124.55
|
| Rate for Payer: First Health Commercial |
$1,190.70
|
| Rate for Payer: First Health Workers Compensation |
$510.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,190.70
|
| Rate for Payer: GEHA Commercial |
$1,058.40
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,190.70
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,203.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$926.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,190.70
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,256.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$992.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,230.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$529.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$361.18
|
|
|
PAROTID DUCT DIVERSION
|
Facility
|
OP
|
$1,058.00
|
|
|
Service Code
|
CPT 42507
|
| Hospital Charge Code |
6142507
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.83 |
| 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 |
$634.80
|
| 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 |
$634.80
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$899.30
|
| Rate for Payer: First Health Commercial |
$952.20
|
| Rate for Payer: First Health Workers Compensation |
$408.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$952.20
|
| Rate for Payer: GEHA Commercial |
$846.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$952.20
|
| 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 |
$962.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$740.60
|
| Rate for Payer: One Health Plan PPO/POS |
$952.20
|
| 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 |
$1,005.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$793.50
|
| 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 |
$983.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$423.20
|
| 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 |
$288.83
|
|
|
PAROTID DUCT DIVERSION
|
Facility
|
IP
|
$1,323.00
|
|
|
Service Code
|
CPT 42510
|
| Hospital Charge Code |
6142510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$361.18 |
| Max. Negotiated Rate |
$1,256.85 |
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna Commercial |
$1,124.55
|
| Rate for Payer: First Health Commercial |
$1,190.70
|
| Rate for Payer: First Health Workers Compensation |
$510.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,190.70
|
| Rate for Payer: GEHA Commercial |
$926.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,190.70
|
| Rate for Payer: Multiplan All |
$1,203.93
|
| Rate for Payer: OMNI Networks Commercial |
$926.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,190.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,256.85
|
| Rate for Payer: Three Rivers Provider Network All |
$992.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,230.39
|
| Rate for Payer: Zelis Auto |
$529.20
|
| Rate for Payer: Zelis Worker's Compensation |
$361.18
|
|
|
PARoxetine HCL TAB 10MG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 50268064011
|
| Hospital Charge Code |
3300691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
PARoxetine HCL TAB 10MG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 50268064011
|
| Hospital Charge Code |
3300691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
PARoxetine HCL TAB SR 24HR 12.5MG
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 00378200393
|
| Hospital Charge Code |
3300692
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$23.80
|
| Rate for Payer: First Health Commercial |
$25.20
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$25.20
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$25.20
|
| Rate for Payer: Humana ChoiceCare |
$7.28
|
| Rate for Payer: Multiplan All |
$25.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.80
|
| Rate for Payer: OMNI Networks Commercial |
$19.60
|
| Rate for Payer: One Health Plan PPO/POS |
$25.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26.60
|
| Rate for Payer: Three Rivers Provider Network All |
$21.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.04
|
| Rate for Payer: Zelis Auto |
$11.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
PARoxetine HCL TAB SR 24HR 12.5MG
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 00378200393
|
| Hospital Charge Code |
3300692
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$23.80
|
| Rate for Payer: First Health Commercial |
$25.20
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$25.20
|
| Rate for Payer: GEHA Commercial |
$19.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$25.20
|
| Rate for Payer: Multiplan All |
$25.48
|
| Rate for Payer: OMNI Networks Commercial |
$19.60
|
| Rate for Payer: One Health Plan PPO/POS |
$25.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26.60
|
| Rate for Payer: Three Rivers Provider Network All |
$21.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.04
|
| Rate for Payer: Zelis Auto |
$11.20
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
PARoxetine HCL TAB SR 24HR 25MG
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
NDC 50268064015
|
| Hospital Charge Code |
3300693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$23.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.40
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.50
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
PARoxetine HCL TAB SR 24HR 25MG
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
NDC 50268064015
|
| Hospital Charge Code |
3300693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$20.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
6128825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$570.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna Commercial |
$808.35
|
| Rate for Payer: First Health Commercial |
$855.90
|
| Rate for Payer: First Health Workers Compensation |
$367.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.90
|
| Rate for Payer: GEHA Commercial |
$760.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$865.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$665.70
|
| Rate for Payer: One Health Plan PPO/POS |
$855.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$903.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$713.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$884.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$380.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$259.62
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
6128825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$903.45 |
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna Commercial |
$808.35
|
| Rate for Payer: First Health Commercial |
$855.90
|
| Rate for Payer: First Health Workers Compensation |
$367.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.90
|
| Rate for Payer: GEHA Commercial |
$665.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.90
|
| Rate for Payer: Multiplan All |
$865.41
|
| Rate for Payer: OMNI Networks Commercial |
$665.70
|
| Rate for Payer: One Health Plan PPO/POS |
$855.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$903.45
|
| Rate for Payer: Three Rivers Provider Network All |
$713.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$884.43
|
| Rate for Payer: Zelis Auto |
$380.40
|
| Rate for Payer: Zelis Worker's Compensation |
$259.62
|
|
|
PARTIAL EXCISION DISTAL PHALANX FINGER
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
20300034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$818.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$1,091.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$545.60
|
| 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 |
$372.37
|
|
|
PARTIAL EXCISION DISTAL PHALANX FINGER
|
Facility
|
OP
|
$8,162.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
8126236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$7,753.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,897.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cigna Commercial |
$6,937.70
|
| Rate for Payer: First Health Commercial |
$7,345.80
|
| Rate for Payer: First Health Workers Compensation |
$3,151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,345.80
|
| Rate for Payer: GEHA Commercial |
$6,529.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,345.80
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$7,427.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$5,713.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,345.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,753.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$6,121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,590.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$3,264.80
|
| 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 |
$2,228.23
|
|
|
PARTIAL EXCISION DISTAL PHALANX FINGER
|
Facility
|
IP
|
$8,284.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
1900034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,261.53 |
| Max. Negotiated Rate |
$7,869.80 |
| Rate for Payer: Cash Price |
$4,970.40
|
| Rate for Payer: Cigna Commercial |
$7,041.40
|
| Rate for Payer: First Health Commercial |
$7,455.60
|
| Rate for Payer: First Health Workers Compensation |
$3,198.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,455.60
|
| Rate for Payer: GEHA Commercial |
$5,798.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,455.60
|
| Rate for Payer: Multiplan All |
$7,538.44
|
| Rate for Payer: OMNI Networks Commercial |
$5,798.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,455.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,869.80
|
| Rate for Payer: Three Rivers Provider Network All |
$6,213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,704.12
|
| Rate for Payer: Zelis Auto |
$3,313.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2,261.53
|
|
|
PARTIAL EXCISION DISTAL PHALANX FINGER
|
Facility
|
OP
|
$8,284.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
1900034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$7,869.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,970.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$4,970.40
|
| Rate for Payer: Cash Price |
$4,970.40
|
| Rate for Payer: Cigna Commercial |
$7,041.40
|
| Rate for Payer: First Health Commercial |
$7,455.60
|
| Rate for Payer: First Health Workers Compensation |
$3,198.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,455.60
|
| Rate for Payer: GEHA Commercial |
$6,627.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,455.60
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$7,538.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$5,798.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,455.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,869.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$6,213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,704.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$3,313.60
|
| 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 |
$2,261.53
|
|
|
PARTIAL EXCISION DISTAL PHALANX FINGER
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
20300034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$954.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
PARTIAL EXCISION DISTAL PHALANX FINGER
|
Facility
|
IP
|
$8,162.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
8126236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,228.23 |
| Max. Negotiated Rate |
$7,753.90 |
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cigna Commercial |
$6,937.70
|
| Rate for Payer: First Health Commercial |
$7,345.80
|
| Rate for Payer: First Health Workers Compensation |
$3,151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,345.80
|
| Rate for Payer: GEHA Commercial |
$5,713.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,345.80
|
| Rate for Payer: Multiplan All |
$7,427.42
|
| Rate for Payer: OMNI Networks Commercial |
$5,713.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,345.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,753.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,590.66
|
| Rate for Payer: Zelis Auto |
$3,264.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,228.23
|
|
|
PARTIAL EXCISION OF LIP
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 40510
|
| Hospital Charge Code |
6140510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.89 |
| Max. Negotiated Rate |
$6,158.84 |
| 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 |
$551.40
|
| 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 |
$3,079.42
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$781.15
|
| Rate for Payer: First Health Commercial |
$827.10
|
| Rate for Payer: First Health Workers Compensation |
$354.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$827.10
|
| Rate for Payer: GEHA Commercial |
$735.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$827.10
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$836.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$643.30
|
| Rate for Payer: One Health Plan PPO/POS |
$827.10
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$873.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$689.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$854.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$367.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$250.89
|
|
