|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
6128160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.28 |
| 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 |
$411.60
|
| 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 |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$264.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$548.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| 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 |
$624.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| 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 |
$637.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$274.40
|
| 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 |
$187.28
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
6128153
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.64 |
| 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 |
$401.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cigna Commercial |
$568.65
|
| Rate for Payer: First Health Commercial |
$602.10
|
| Rate for Payer: First Health Workers Compensation |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$602.10
|
| Rate for Payer: GEHA Commercial |
$535.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$602.10
|
| 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 |
$608.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$468.30
|
| Rate for Payer: One Health Plan PPO/POS |
$602.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$635.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$501.75
|
| 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 |
$622.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$267.60
|
| 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 |
$182.64
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 28126
|
| Hospital Charge Code |
6128126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$172.26 |
| 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 |
$378.60
|
| 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 |
$378.60
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$536.35
|
| Rate for Payer: First Health Commercial |
$567.90
|
| Rate for Payer: First Health Workers Compensation |
$243.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$567.90
|
| Rate for Payer: GEHA Commercial |
$504.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$567.90
|
| 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 |
$574.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$441.70
|
| Rate for Payer: One Health Plan PPO/POS |
$567.90
|
| 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 |
$599.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$473.25
|
| 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 |
$586.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$252.40
|
| 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 |
$172.26
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
8228124
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
6128160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.28 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$264.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$480.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Worker's Compensation |
$187.28
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
6128124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| 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 |
$502.80
|
| 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 |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$670.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| 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 |
$762.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| 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 |
$796.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| 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 |
$779.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$335.20
|
| 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 |
$228.77
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
6128124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$586.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 28126
|
| Hospital Charge Code |
6128126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$599.45 |
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$536.35
|
| Rate for Payer: First Health Commercial |
$567.90
|
| Rate for Payer: First Health Workers Compensation |
$243.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$567.90
|
| Rate for Payer: GEHA Commercial |
$441.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$567.90
|
| Rate for Payer: Multiplan All |
$574.21
|
| Rate for Payer: OMNI Networks Commercial |
$441.70
|
| Rate for Payer: One Health Plan PPO/POS |
$567.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$599.45
|
| Rate for Payer: Three Rivers Provider Network All |
$473.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$586.83
|
| Rate for Payer: Zelis Auto |
$252.40
|
| Rate for Payer: Zelis Worker's Compensation |
$172.26
|
|
|
PARTIAL REMOVAL OF TONGUE
|
Facility
|
OP
|
$2,217.00
|
|
|
Service Code
|
CPT 41120
|
| Hospital Charge Code |
6141120
|
|
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 |
$2,524.05
|
| 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 |
$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 |
$1,330.20
|
| 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 |
$2,040.27
|
| 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 |
$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 |
$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 |
$2,040.27
|
| 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
|
|
|
PARTIAL REMOVAL OF TONGUE
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
CPT 41130
|
| Hospital Charge Code |
6141130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$685.75 |
| Max. Negotiated Rate |
$2,605.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,645.80
|
| Rate for Payer: Cash Price |
$1,645.80
|
| Rate for Payer: Cigna Commercial |
$2,331.55
|
| Rate for Payer: First Health Commercial |
$2,468.70
|
| Rate for Payer: First Health Workers Compensation |
$1,059.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,468.70
|
| Rate for Payer: GEHA Commercial |
$2,194.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,468.70
|
| Rate for Payer: Humana ChoiceCare |
$713.18
|
| Rate for Payer: Multiplan All |
$2,496.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,645.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,920.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,468.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,605.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,057.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,413.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$685.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,550.99
|
| Rate for Payer: Zelis Auto |
$1,097.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.50
|
| Rate for Payer: Zelis Worker's Compensation |
$748.84
|
|
|
PARTIAL REMOVAL OF TONGUE
|
Facility
|
IP
|
$2,217.00
|
|
|
Service Code
|
CPT 41120
|
| Hospital Charge Code |
6141120
|
|
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
|
|
|
PARTIAL REMOVAL OF TONGUE
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
CPT 41130
|
| Hospital Charge Code |
6141130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$748.84 |
| Max. Negotiated Rate |
$2,605.85 |
| Rate for Payer: Cash Price |
$1,645.80
|
| Rate for Payer: Cigna Commercial |
$2,331.55
|
| Rate for Payer: First Health Commercial |
$2,468.70
|
| Rate for Payer: First Health Workers Compensation |
$1,059.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,468.70
|
| Rate for Payer: GEHA Commercial |
$1,920.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,468.70
|
| Rate for Payer: Multiplan All |
$2,496.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,920.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,468.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,605.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,057.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,550.99
|
| Rate for Payer: Zelis Auto |
$1,097.20
|
| Rate for Payer: Zelis Worker's Compensation |
$748.84
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 25119
|
| Hospital Charge Code |
6125119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$601.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$801.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$911.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$951.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$931.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$400.80
|
| 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 |
$273.55
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 25150
|
| Hospital Charge Code |
6125150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.77 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cigna Commercial |
$980.05
|
| Rate for Payer: First Health Commercial |
$1,037.70
|
| Rate for Payer: First Health Workers Compensation |
$445.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,037.70
|
| Rate for Payer: GEHA Commercial |
$922.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,037.70
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,049.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$807.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,037.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,095.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$864.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,072.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$461.20
|
| 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 |
$314.77
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 25150
|
| Hospital Charge Code |
6125150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.77 |
| Max. Negotiated Rate |
$1,095.35 |
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cigna Commercial |
$980.05
|
| Rate for Payer: First Health Commercial |
$1,037.70
|
| Rate for Payer: First Health Workers Compensation |
$445.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,037.70
|
| Rate for Payer: GEHA Commercial |
$807.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,037.70
|
| Rate for Payer: Multiplan All |
$1,049.23
|
| Rate for Payer: OMNI Networks Commercial |
$807.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,037.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,095.35
|
| Rate for Payer: Three Rivers Provider Network All |
$864.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,072.29
|
| Rate for Payer: Zelis Auto |
$461.20
|
| Rate for Payer: Zelis Worker's Compensation |
$314.77
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 25119
|
| Hospital Charge Code |
6125119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$701.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| Rate for Payer: Multiplan All |
$911.82
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$951.90
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$931.86
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 25240
|
| Hospital Charge Code |
6125240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$604.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 25240
|
| Hospital Charge Code |
6125240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$691.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$345.60
|
| 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 |
$235.87
|
|
|
PARTIAL REMOVAL OF VULVA
|
Facility
|
IP
|
$2,862.65
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
6156620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$781.50 |
| Max. Negotiated Rate |
$2,719.52 |
| Rate for Payer: Cash Price |
$1,717.59
|
| Rate for Payer: Cigna Commercial |
$2,433.25
|
| Rate for Payer: First Health Commercial |
$2,576.39
|
| Rate for Payer: First Health Workers Compensation |
$1,105.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,576.39
|
| Rate for Payer: GEHA Commercial |
$2,003.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,576.39
|
| Rate for Payer: Multiplan All |
$2,605.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,003.86
|
| Rate for Payer: One Health Plan PPO/POS |
$2,576.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,719.52
|
| Rate for Payer: Three Rivers Provider Network All |
$2,146.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,662.26
|
| Rate for Payer: Zelis Auto |
$1,145.06
|
| Rate for Payer: Zelis Worker's Compensation |
$781.50
|
|
|
PARTIAL REMOVAL OF VULVA
|
Facility
|
OP
|
$2,862.65
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
6156620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$781.50 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,717.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$1,717.59
|
| Rate for Payer: Cash Price |
$1,717.59
|
| Rate for Payer: Cigna Commercial |
$2,433.25
|
| Rate for Payer: First Health Commercial |
$2,576.39
|
| Rate for Payer: First Health Workers Compensation |
$1,105.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,576.39
|
| Rate for Payer: GEHA Commercial |
$2,290.12
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,576.39
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$2,605.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,003.86
|
| Rate for Payer: One Health Plan PPO/POS |
$2,576.39
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,719.52
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,146.99
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,662.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$1,145.06
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$781.50
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
CPT 60212
|
| Hospital Charge Code |
6160212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$572.75 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,258.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cigna Commercial |
$1,783.30
|
| Rate for Payer: First Health Commercial |
$1,888.20
|
| Rate for Payer: First Health Workers Compensation |
$810.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,888.20
|
| Rate for Payer: GEHA Commercial |
$1,678.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,888.20
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,909.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,468.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,888.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,993.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,573.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,951.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$839.20
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$572.75
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
CPT 60212
|
| Hospital Charge Code |
6160212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$572.75 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cigna Commercial |
$1,783.30
|
| Rate for Payer: First Health Commercial |
$1,888.20
|
| Rate for Payer: First Health Workers Compensation |
$810.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,888.20
|
| Rate for Payer: GEHA Commercial |
$1,468.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,888.20
|
| Rate for Payer: Multiplan All |
$1,909.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,468.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,888.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,993.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,573.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,951.14
|
| Rate for Payer: Zelis Auto |
$839.20
|
| Rate for Payer: Zelis Worker's Compensation |
$572.75
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
IP
|
$1,473.00
|
|
|
Service Code
|
CPT 60210
|
| Hospital Charge Code |
6160210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.13 |
| Max. Negotiated Rate |
$1,399.35 |
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,031.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,399.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,369.89
|
| Rate for Payer: Zelis Auto |
$589.20
|
| Rate for Payer: Zelis Worker's Compensation |
$402.13
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
OP
|
$1,473.00
|
|
|
Service Code
|
CPT 60210
|
| Hospital Charge Code |
6160210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.13 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$883.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,178.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,399.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,369.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$589.20
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$402.13
|
|
|
PARTICAL MASTECTOMY
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
6119301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.01 |
| Max. Negotiated Rate |
$1,291.05 |
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cigna Commercial |
$1,155.15
|
| Rate for Payer: First Health Commercial |
$1,223.10
|
| Rate for Payer: First Health Workers Compensation |
$524.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,223.10
|
| Rate for Payer: GEHA Commercial |
$951.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,223.10
|
| Rate for Payer: Multiplan All |
$1,236.69
|
| Rate for Payer: OMNI Networks Commercial |
$951.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,223.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,291.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,019.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,263.87
|
| Rate for Payer: Zelis Auto |
$543.60
|
| Rate for Payer: Zelis Worker's Compensation |
$371.01
|
|
