|
REMOVAL OF BLADDER CYST
|
Facility
|
IP
|
$1,313.00
|
|
|
Service Code
|
CPT 51500
|
| Hospital Charge Code |
6151500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$358.45 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: First Health Workers Compensation |
$506.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$919.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: Zelis Auto |
$525.20
|
| Rate for Payer: Zelis Worker's Compensation |
$358.45
|
|
|
REMOVAL OF BLADDER CYST
|
Facility
|
OP
|
$1,313.00
|
|
|
Service Code
|
CPT 51500
|
| Hospital Charge Code |
6151500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$358.45 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$787.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: First Health Workers Compensation |
$506.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$1,050.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| 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 |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$525.20
|
| 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 |
$358.45
|
|
|
REMOVAL OF BLADDER LESION
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
CPT 51530
|
| Hospital Charge Code |
6151530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$411.25 |
| Max. Negotiated Rate |
$1,562.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$987.00
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cigna Commercial |
$1,398.25
|
| Rate for Payer: First Health Commercial |
$1,480.50
|
| Rate for Payer: First Health Workers Compensation |
$635.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,480.50
|
| Rate for Payer: GEHA Commercial |
$1,316.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,480.50
|
| Rate for Payer: Humana ChoiceCare |
$427.70
|
| Rate for Payer: Multiplan All |
$1,496.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$987.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,151.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,480.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,562.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,447.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,529.85
|
| Rate for Payer: Zelis Auto |
$658.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$822.50
|
| Rate for Payer: Zelis Worker's Compensation |
$449.08
|
|
|
REMOVAL OF BLADDER LESION
|
Facility
|
OP
|
$1,772.00
|
|
|
Service Code
|
CPT 51525
|
| Hospital Charge Code |
6151525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$443.00 |
| Max. Negotiated Rate |
$1,683.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,063.20
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$1,506.20
|
| Rate for Payer: First Health Commercial |
$1,594.80
|
| Rate for Payer: First Health Workers Compensation |
$684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,594.80
|
| Rate for Payer: GEHA Commercial |
$1,417.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,594.80
|
| Rate for Payer: Humana ChoiceCare |
$460.72
|
| Rate for Payer: Multiplan All |
$1,612.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,063.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,240.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,594.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,683.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,559.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$443.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,647.96
|
| Rate for Payer: Zelis Auto |
$708.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$886.00
|
| Rate for Payer: Zelis Worker's Compensation |
$483.76
|
|
|
REMOVAL OF BLADDER LESION
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 51520
|
| Hospital Charge Code |
6151520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.79 |
| Max. Negotiated Rate |
$1,168.50 |
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Cigna Commercial |
$1,045.50
|
| Rate for Payer: First Health Commercial |
$1,107.00
|
| Rate for Payer: First Health Workers Compensation |
$474.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,107.00
|
| Rate for Payer: GEHA Commercial |
$861.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,107.00
|
| Rate for Payer: Multiplan All |
$1,119.30
|
| Rate for Payer: OMNI Networks Commercial |
$861.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,107.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,168.50
|
| Rate for Payer: Three Rivers Provider Network All |
$922.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,143.90
|
| Rate for Payer: Zelis Auto |
$492.00
|
| Rate for Payer: Zelis Worker's Compensation |
$335.79
|
|
|
REMOVAL OF BLADDER LESION
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
CPT 51530
|
| Hospital Charge Code |
6151530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$449.08 |
| Max. Negotiated Rate |
$1,562.75 |
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cigna Commercial |
$1,398.25
|
| Rate for Payer: First Health Commercial |
$1,480.50
|
| Rate for Payer: First Health Workers Compensation |
$635.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,480.50
|
| Rate for Payer: GEHA Commercial |
$1,151.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,480.50
|
| Rate for Payer: Multiplan All |
$1,496.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,151.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,480.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,562.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,529.85
|
| Rate for Payer: Zelis Auto |
$658.00
|
| Rate for Payer: Zelis Worker's Compensation |
$449.08
|
|
|
REMOVAL OF BLADDER LESION
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 51520
|
| Hospital Charge Code |
6151520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.79 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$738.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Cigna Commercial |
$1,045.50
|
| Rate for Payer: First Health Commercial |
$1,107.00
|
| Rate for Payer: First Health Workers Compensation |
$474.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,107.00
|
| Rate for Payer: GEHA Commercial |
$984.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,107.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,119.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$861.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,107.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,168.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$922.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,143.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$492.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$335.79
|
|
|
REMOVAL OF BLADDER LESION
|
Facility
|
IP
|
$1,772.00
|
|
|
Service Code
|
CPT 51525
|
| Hospital Charge Code |
6151525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$483.76 |
| Max. Negotiated Rate |
$1,683.40 |
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$1,506.20
|
| Rate for Payer: First Health Commercial |
$1,594.80
|
| Rate for Payer: First Health Workers Compensation |
$684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,594.80
|
| Rate for Payer: GEHA Commercial |
$1,240.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,594.80
|
| Rate for Payer: Multiplan All |
$1,612.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,240.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,594.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,683.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,647.96
|
| Rate for Payer: Zelis Auto |
$708.80
|
| Rate for Payer: Zelis Worker's Compensation |
$483.76
|
|
|
REMOVAL OF BLADDER & NODES
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 51575
|
| Hospital Charge Code |
6151575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,030.03 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Cash Price |
$2,263.80
|
| Rate for Payer: Cigna Commercial |
$3,207.05
|
| Rate for Payer: First Health Commercial |
$3,395.70
|
| Rate for Payer: First Health Workers Compensation |
$1,456.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,395.70
|
| Rate for Payer: GEHA Commercial |
$2,641.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,395.70
|
| Rate for Payer: Multiplan All |
$3,433.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,641.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,395.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,584.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,829.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,508.89
|
| Rate for Payer: Zelis Auto |
$1,509.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,030.03
|
|
|
REMOVAL OF BLADDER & NODES
|
Facility
|
IP
|
$4,363.00
|
|
|
Service Code
|
CPT 51585
|
| Hospital Charge Code |
6151585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,191.10 |
| Max. Negotiated Rate |
$4,144.85 |
| Rate for Payer: Cash Price |
$2,617.80
|
| Rate for Payer: Cigna Commercial |
$3,708.55
|
| Rate for Payer: First Health Commercial |
$3,926.70
|
| Rate for Payer: First Health Workers Compensation |
$1,684.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,926.70
|
| Rate for Payer: GEHA Commercial |
$3,054.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,926.70
|
| Rate for Payer: Multiplan All |
$3,970.33
|
| Rate for Payer: OMNI Networks Commercial |
$3,054.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,926.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,144.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,272.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,057.59
|
| Rate for Payer: Zelis Auto |
$1,745.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,191.10
|
|
|
REMOVAL OF BLADDER & NODES
|
Facility
|
OP
|
$4,363.00
|
|
|
Service Code
|
CPT 51585
|
| Hospital Charge Code |
6151585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,090.75 |
| Max. Negotiated Rate |
$4,144.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,617.80
|
| Rate for Payer: Cash Price |
$2,617.80
|
| Rate for Payer: Cigna Commercial |
$3,708.55
|
| Rate for Payer: First Health Commercial |
$3,926.70
|
| Rate for Payer: First Health Workers Compensation |
$1,684.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,926.70
|
| Rate for Payer: GEHA Commercial |
$3,490.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,926.70
|
| Rate for Payer: Humana ChoiceCare |
$1,134.38
|
| Rate for Payer: Multiplan All |
$3,970.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,617.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,054.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,926.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,144.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,272.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,839.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,090.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,057.59
|
| Rate for Payer: Zelis Auto |
$1,745.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,181.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,191.10
|
|
|
REMOVAL OF BLADDER & NODES
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 51575
|
| Hospital Charge Code |
6151575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$943.25 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,263.80
|
| Rate for Payer: Cash Price |
$2,263.80
|
| Rate for Payer: Cigna Commercial |
$3,207.05
|
| Rate for Payer: First Health Commercial |
$3,395.70
|
| Rate for Payer: First Health Workers Compensation |
$1,456.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,395.70
|
| Rate for Payer: GEHA Commercial |
$3,018.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,395.70
|
| Rate for Payer: Humana ChoiceCare |
$980.98
|
| Rate for Payer: Multiplan All |
$3,433.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,263.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,641.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,395.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,584.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,829.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,320.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$943.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,508.89
|
| Rate for Payer: Zelis Auto |
$1,509.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,886.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,030.03
|
|
|
REMOVAL OF BLADDER STONE
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 51050
|
| Hospital Charge Code |
6151050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.54 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: First Health Workers Compensation |
$374.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$264.54
|
|
|
REMOVAL OF BLADDER STONE
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 51050
|
| Hospital Charge Code |
6151050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.54 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: First Health Workers Compensation |
$374.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Worker's Compensation |
$264.54
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 20902
|
| Hospital Charge Code |
6120902
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$631.55
|
| Rate for Payer: First Health Commercial |
$668.70
|
| Rate for Payer: First Health Workers Compensation |
$286.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$668.70
|
| Rate for Payer: GEHA Commercial |
$520.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$668.70
|
| Rate for Payer: Multiplan All |
$676.13
|
| Rate for Payer: OMNI Networks Commercial |
$520.10
|
| Rate for Payer: One Health Plan PPO/POS |
$668.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$705.85
|
| Rate for Payer: Three Rivers Provider Network All |
$557.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$690.99
|
| Rate for Payer: Zelis Auto |
$297.20
|
| Rate for Payer: Zelis Worker's Compensation |
$202.84
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
6120900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.34 |
| 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 |
$354.60
|
| 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 |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$502.35
|
| Rate for Payer: First Health Commercial |
$531.90
|
| Rate for Payer: First Health Workers Compensation |
$228.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.90
|
| Rate for Payer: GEHA Commercial |
$472.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.90
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$537.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$413.70
|
| Rate for Payer: One Health Plan PPO/POS |
$531.90
|
| 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 |
$561.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$443.25
|
| 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 |
$549.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$236.40
|
| 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 |
$161.34
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 20902
|
| Hospital Charge Code |
6120902
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$202.84 |
| 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 |
$445.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$631.55
|
| Rate for Payer: First Health Commercial |
$668.70
|
| Rate for Payer: First Health Workers Compensation |
$286.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$668.70
|
| Rate for Payer: GEHA Commercial |
$594.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$668.70
|
| 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 |
$676.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$520.10
|
| Rate for Payer: One Health Plan PPO/POS |
$668.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$705.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$557.25
|
| 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 |
$690.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$297.20
|
| 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 |
$202.84
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
6120900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$561.45 |
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$502.35
|
| Rate for Payer: First Health Commercial |
$531.90
|
| Rate for Payer: First Health Workers Compensation |
$228.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.90
|
| Rate for Payer: GEHA Commercial |
$413.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.90
|
| Rate for Payer: Multiplan All |
$537.81
|
| Rate for Payer: OMNI Networks Commercial |
$413.70
|
| Rate for Payer: One Health Plan PPO/POS |
$531.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$561.45
|
| Rate for Payer: Three Rivers Provider Network All |
$443.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$549.63
|
| Rate for Payer: Zelis Auto |
$236.40
|
| Rate for Payer: Zelis Worker's Compensation |
$161.34
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 23146
|
| Hospital Charge Code |
6123146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.62 |
| 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 |
$759.60
|
| 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 |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$1,012.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| 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 |
$1,152.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| 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 |
$1,202.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| 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 |
$1,177.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$506.40
|
| 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 |
$345.62
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 23140
|
| Hospital Charge Code |
6123140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.12 |
| 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 |
$655.20
|
| 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 |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$928.20
|
| Rate for Payer: First Health Commercial |
$982.80
|
| Rate for Payer: First Health Workers Compensation |
$421.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$982.80
|
| Rate for Payer: GEHA Commercial |
$873.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$982.80
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$993.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$764.40
|
| Rate for Payer: One Health Plan PPO/POS |
$982.80
|
| 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 |
$1,037.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$819.00
|
| 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 |
$1,015.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$436.80
|
| 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 |
$298.12
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
CPT 23145
|
| Hospital Charge Code |
6123145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.75 |
| Max. Negotiated Rate |
$1,352.80 |
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$1,210.40
|
| Rate for Payer: First Health Commercial |
$1,281.60
|
| Rate for Payer: First Health Workers Compensation |
$549.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,281.60
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,281.60
|
| Rate for Payer: Multiplan All |
$1,295.84
|
| Rate for Payer: OMNI Networks Commercial |
$996.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,281.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,352.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,324.32
|
| Rate for Payer: Zelis Auto |
$569.60
|
| Rate for Payer: Zelis Worker's Compensation |
$388.75
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 23140
|
| Hospital Charge Code |
6123140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.12 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$928.20
|
| Rate for Payer: First Health Commercial |
$982.80
|
| Rate for Payer: First Health Workers Compensation |
$421.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$982.80
|
| Rate for Payer: GEHA Commercial |
$764.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$982.80
|
| Rate for Payer: Multiplan All |
$993.72
|
| Rate for Payer: OMNI Networks Commercial |
$764.40
|
| Rate for Payer: One Health Plan PPO/POS |
$982.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,037.40
|
| Rate for Payer: Three Rivers Provider Network All |
$819.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,015.56
|
| Rate for Payer: Zelis Auto |
$436.80
|
| Rate for Payer: Zelis Worker's Compensation |
$298.12
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 23145
|
| Hospital Charge Code |
6123145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.75 |
| 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 |
$854.40
|
| 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 |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$1,210.40
|
| Rate for Payer: First Health Commercial |
$1,281.60
|
| Rate for Payer: First Health Workers Compensation |
$549.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,281.60
|
| Rate for Payer: GEHA Commercial |
$1,139.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,281.60
|
| 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 |
$1,295.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$996.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,281.60
|
| 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 |
$1,352.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.00
|
| 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 |
$1,324.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$569.60
|
| 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 |
$388.75
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 23146
|
| Hospital Charge Code |
6123146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.62 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$886.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
REMOVAL OF BRAIN LESION
|
Facility
|
OP
|
$6,794.00
|
|
|
Service Code
|
CPT 61521
|
| Hospital Charge Code |
6161521
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,698.50 |
| Max. Negotiated Rate |
$6,454.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,076.40
|
| Rate for Payer: Cash Price |
$4,076.40
|
| Rate for Payer: Cigna Commercial |
$5,774.90
|
| Rate for Payer: First Health Commercial |
$6,114.60
|
| Rate for Payer: First Health Workers Compensation |
$2,623.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,114.60
|
| Rate for Payer: GEHA Commercial |
$5,435.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,114.60
|
| Rate for Payer: Humana ChoiceCare |
$1,766.44
|
| Rate for Payer: Multiplan All |
$6,182.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,076.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,755.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,114.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,454.30
|
| Rate for Payer: Three Rivers Provider Network All |
$5,095.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,978.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,698.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,318.42
|
| Rate for Payer: Zelis Auto |
$2,717.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,397.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,854.76
|
|
