|
REMOVAL OF ADENOIDS
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 42831
|
| Hospital Charge Code |
6142831
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$401.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: Zelis Auto |
$229.60
|
| Rate for Payer: Zelis Worker's Compensation |
$156.70
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 42831
|
| Hospital Charge Code |
6142831
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| 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 |
$344.40
|
| 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 |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| 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 |
$522.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| 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 |
$533.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$229.60
|
| 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 |
$156.70
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 42835
|
| Hospital Charge Code |
6142835
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.62 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$228.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Worker's Compensation |
$161.62
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 42836
|
| Hospital Charge Code |
6142836
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$169.26 |
| 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 |
$372.00
|
| 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 |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$527.00
|
| Rate for Payer: First Health Commercial |
$558.00
|
| Rate for Payer: First Health Workers Compensation |
$239.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.00
|
| Rate for Payer: GEHA Commercial |
$496.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.00
|
| 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 |
$564.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$434.00
|
| Rate for Payer: One Health Plan PPO/POS |
$558.00
|
| 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 |
$589.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$465.00
|
| 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 |
$576.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$248.00
|
| 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 |
$169.26
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 42830
|
| Hospital Charge Code |
6142830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cigna Commercial |
$452.20
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: First Health Workers Compensation |
$205.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$478.80
|
| Rate for Payer: GEHA Commercial |
$372.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$478.80
|
| Rate for Payer: Multiplan All |
$484.12
|
| Rate for Payer: OMNI Networks Commercial |
$372.40
|
| Rate for Payer: One Health Plan PPO/POS |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$505.40
|
| Rate for Payer: Three Rivers Provider Network All |
$399.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$494.76
|
| Rate for Payer: Zelis Auto |
$212.80
|
| Rate for Payer: Zelis Worker's Compensation |
$145.24
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 42835
|
| Hospital Charge Code |
6142835
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.62 |
| 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 |
$355.20
|
| 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 |
$3,079.42
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$228.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$473.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| 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 |
$538.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| 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 |
$562.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| 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 |
$550.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$236.80
|
| 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 |
$161.62
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 42836
|
| Hospital Charge Code |
6142836
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$169.26 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$527.00
|
| Rate for Payer: First Health Commercial |
$558.00
|
| Rate for Payer: First Health Workers Compensation |
$239.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.00
|
| Rate for Payer: GEHA Commercial |
$434.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.00
|
| Rate for Payer: Multiplan All |
$564.20
|
| Rate for Payer: OMNI Networks Commercial |
$434.00
|
| Rate for Payer: One Health Plan PPO/POS |
$558.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.00
|
| Rate for Payer: Three Rivers Provider Network All |
$465.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$576.60
|
| Rate for Payer: Zelis Auto |
$248.00
|
| Rate for Payer: Zelis Worker's Compensation |
$169.26
|
|
|
REMOVAL OF ANAL FISSURE
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
6146200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
REMOVAL OF ANAL FISSURE
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
6146200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
REMOVAL OF ANAL TAGS
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
6146230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna Commercial |
$453.90
|
| Rate for Payer: First Health Commercial |
$480.60
|
| Rate for Payer: First Health Workers Compensation |
$206.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.60
|
| Rate for Payer: GEHA Commercial |
$427.20
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.60
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$485.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$373.80
|
| Rate for Payer: One Health Plan PPO/POS |
$480.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$507.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$400.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$213.60
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$145.78
|
|
|
REMOVAL OF ANAL TAGS
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
6146230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna Commercial |
$453.90
|
| Rate for Payer: First Health Commercial |
$480.60
|
| Rate for Payer: First Health Workers Compensation |
$206.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.60
|
| Rate for Payer: GEHA Commercial |
$373.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.60
|
| Rate for Payer: Multiplan All |
$485.94
|
| Rate for Payer: OMNI Networks Commercial |
$373.80
|
| Rate for Payer: One Health Plan PPO/POS |
$480.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$507.30
|
| Rate for Payer: Three Rivers Provider Network All |
$400.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.62
|
| Rate for Payer: Zelis Auto |
$213.60
|
| Rate for Payer: Zelis Worker's Compensation |
$145.78
|
|
|
REMOVAL OF ANAL TAGS
|
Facility
|
IP
|
$860.67
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
20346230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.96 |
| Max. Negotiated Rate |
$817.64 |
| Rate for Payer: Cash Price |
$516.40
|
| Rate for Payer: Cigna Commercial |
$731.57
|
| Rate for Payer: First Health Commercial |
$774.60
|
| Rate for Payer: First Health Workers Compensation |
$332.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.60
|
| Rate for Payer: GEHA Commercial |
$602.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.60
|
| Rate for Payer: Multiplan All |
$783.21
|
| Rate for Payer: OMNI Networks Commercial |
$602.47
|
| Rate for Payer: One Health Plan PPO/POS |
$774.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.64
|
| Rate for Payer: Three Rivers Provider Network All |
$645.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$800.42
|
| Rate for Payer: Zelis Auto |
$344.27
|
| Rate for Payer: Zelis Worker's Compensation |
$234.96
|
|
|
REMOVAL OF ANAL TAGS
|
Facility
|
OP
|
$860.67
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
20346230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.96 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$516.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$516.40
|
| Rate for Payer: Cash Price |
$516.40
|
| Rate for Payer: Cigna Commercial |
$731.57
|
| Rate for Payer: First Health Commercial |
$774.60
|
| Rate for Payer: First Health Workers Compensation |
$332.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.60
|
| Rate for Payer: GEHA Commercial |
$688.54
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.60
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$783.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$602.47
|
| Rate for Payer: One Health Plan PPO/POS |
$774.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.64
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$645.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$800.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$344.27
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$234.96
|
|
|
REMOVAL OF ANKLE BONE
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
CPT 28130
|
| Hospital Charge Code |
6128130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.90 |
| Max. Negotiated Rate |
$1,245.45 |
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cigna Commercial |
$1,114.35
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: First Health Workers Compensation |
$506.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,179.90
|
| Rate for Payer: GEHA Commercial |
$917.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,179.90
|
| Rate for Payer: Multiplan All |
$1,193.01
|
| Rate for Payer: OMNI Networks Commercial |
$917.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,179.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,245.45
|
| Rate for Payer: Three Rivers Provider Network All |
$983.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,219.23
|
| Rate for Payer: Zelis Auto |
$524.40
|
| Rate for Payer: Zelis Worker's Compensation |
$357.90
|
|
|
REMOVAL OF ANKLE BONE
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
CPT 28130
|
| Hospital Charge Code |
6128130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.90 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$786.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cigna Commercial |
$1,114.35
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: First Health Workers Compensation |
$506.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,179.90
|
| Rate for Payer: GEHA Commercial |
$1,048.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,179.90
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,193.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$917.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,179.90
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,245.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$983.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,219.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$524.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$357.90
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 28100
|
| Hospital Charge Code |
6128100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.87 |
| 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 |
$505.20
|
| 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 |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| 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 |
$799.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| 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 |
$783.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$336.80
|
| 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 |
$229.87
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 28100
|
| Hospital Charge Code |
6128100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Worker's Compensation |
$229.87
|
|
|
REMOVAL OF ANKLE IMPLANT
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 27704
|
| Hospital Charge Code |
6127704
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.87 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna Commercial |
$1,002.15
|
| Rate for Payer: First Health Commercial |
$1,061.10
|
| Rate for Payer: First Health Workers Compensation |
$455.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,061.10
|
| Rate for Payer: GEHA Commercial |
$825.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,061.10
|
| Rate for Payer: Multiplan All |
$1,072.89
|
| Rate for Payer: OMNI Networks Commercial |
$825.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,061.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,120.05
|
| Rate for Payer: Three Rivers Provider Network All |
$884.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,096.47
|
| Rate for Payer: Zelis Auto |
$471.60
|
| Rate for Payer: Zelis Worker's Compensation |
$321.87
|
|
|
REMOVAL OF ANKLE IMPLANT
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 27704
|
| Hospital Charge Code |
6127704
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.87 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$707.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna Commercial |
$1,002.15
|
| Rate for Payer: First Health Commercial |
$1,061.10
|
| Rate for Payer: First Health Workers Compensation |
$455.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,061.10
|
| Rate for Payer: GEHA Commercial |
$943.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,061.10
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,072.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$825.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,061.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,120.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$884.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,096.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$471.60
|
| 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 |
$321.87
|
|
|
REMOVAL OF ANORECTAL LESION
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 45108
|
| Hospital Charge Code |
6145108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$901.55 |
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cigna Commercial |
$806.65
|
| Rate for Payer: First Health Commercial |
$854.10
|
| Rate for Payer: First Health Workers Compensation |
$366.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$854.10
|
| Rate for Payer: GEHA Commercial |
$664.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$854.10
|
| Rate for Payer: Multiplan All |
$863.59
|
| Rate for Payer: OMNI Networks Commercial |
$664.30
|
| Rate for Payer: One Health Plan PPO/POS |
$854.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$901.55
|
| Rate for Payer: Three Rivers Provider Network All |
$711.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$882.57
|
| Rate for Payer: Zelis Auto |
$379.60
|
| Rate for Payer: Zelis Worker's Compensation |
$259.08
|
|
|
REMOVAL OF ANORECTAL LESION
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 45108
|
| Hospital Charge Code |
6145108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$569.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cigna Commercial |
$806.65
|
| Rate for Payer: First Health Commercial |
$854.10
|
| Rate for Payer: First Health Workers Compensation |
$366.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$854.10
|
| Rate for Payer: GEHA Commercial |
$759.20
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$854.10
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$863.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$664.30
|
| Rate for Payer: One Health Plan PPO/POS |
$854.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$901.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$711.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$882.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$379.60
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$259.08
|
|
|
REMOVAL OF ARM BONE LESION
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 24134
|
| Hospital Charge Code |
6124134
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$1,300.50
|
| Rate for Payer: First Health Commercial |
$1,377.00
|
| Rate for Payer: First Health Workers Compensation |
$590.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,377.00
|
| Rate for Payer: GEHA Commercial |
$1,071.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,377.00
|
| Rate for Payer: Multiplan All |
$1,392.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,071.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,377.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,453.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,147.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,422.90
|
| Rate for Payer: Zelis Auto |
$612.00
|
| Rate for Payer: Zelis Worker's Compensation |
$417.69
|
|
|
REMOVAL OF ARM BONE LESION
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 24134
|
| Hospital Charge Code |
6124134
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$918.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$1,300.50
|
| Rate for Payer: First Health Commercial |
$1,377.00
|
| Rate for Payer: First Health Workers Compensation |
$590.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,377.00
|
| Rate for Payer: GEHA Commercial |
$1,224.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,377.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,392.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,071.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,377.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,453.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,147.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,422.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$612.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$417.69
|
|
|
REMOVAL OF BLADDER
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT 51570
|
| Hospital Charge Code |
6151570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$764.75 |
| Max. Negotiated Rate |
$2,906.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,835.40
|
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cigna Commercial |
$2,600.15
|
| Rate for Payer: First Health Commercial |
$2,753.10
|
| Rate for Payer: First Health Workers Compensation |
$1,181.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,753.10
|
| Rate for Payer: GEHA Commercial |
$2,447.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,753.10
|
| Rate for Payer: Humana ChoiceCare |
$795.34
|
| Rate for Payer: Multiplan All |
$2,783.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,835.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,141.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,753.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,906.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,294.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,691.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$764.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,844.87
|
| Rate for Payer: Zelis Auto |
$1,223.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,529.50
|
| Rate for Payer: Zelis Worker's Compensation |
$835.11
|
|
|
REMOVAL OF BLADDER
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT 51570
|
| Hospital Charge Code |
6151570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$835.11 |
| Max. Negotiated Rate |
$2,906.05 |
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cigna Commercial |
$2,600.15
|
| Rate for Payer: First Health Commercial |
$2,753.10
|
| Rate for Payer: First Health Workers Compensation |
$1,181.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,753.10
|
| Rate for Payer: GEHA Commercial |
$2,141.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,753.10
|
| Rate for Payer: Multiplan All |
$2,783.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,141.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,753.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,906.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,294.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,844.87
|
| Rate for Payer: Zelis Auto |
$1,223.60
|
| Rate for Payer: Zelis Worker's Compensation |
$835.11
|
|
