|
REMOVAL OF BRAIN LESION
|
Facility
|
IP
|
$6,794.00
|
|
|
Service Code
|
CPT 61521
|
| Hospital Charge Code |
6161521
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,854.76 |
| Max. Negotiated Rate |
$6,454.30 |
| 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 |
$4,755.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,114.60
|
| Rate for Payer: Multiplan All |
$6,182.54
|
| 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: United Payors & United Providers UP&UP |
$6,318.42
|
| Rate for Payer: Zelis Auto |
$2,717.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,854.76
|
|
|
REMOVAL OF BRAIN LESION
|
Facility
|
OP
|
$4,689.00
|
|
|
Service Code
|
CPT 61510
|
| Hospital Charge Code |
6161510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,172.25 |
| Max. Negotiated Rate |
$4,454.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,813.40
|
| Rate for Payer: Cash Price |
$2,813.40
|
| Rate for Payer: Cigna Commercial |
$3,985.65
|
| Rate for Payer: First Health Commercial |
$4,220.10
|
| Rate for Payer: First Health Workers Compensation |
$1,810.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,220.10
|
| Rate for Payer: GEHA Commercial |
$3,751.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,220.10
|
| Rate for Payer: Humana ChoiceCare |
$1,219.14
|
| Rate for Payer: Multiplan All |
$4,266.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,813.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,282.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,220.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,454.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,516.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,126.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,172.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,360.77
|
| Rate for Payer: Zelis Auto |
$1,875.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,344.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,280.10
|
|
|
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
|
|
|
REMOVAL OF BREAST TISSUE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
6119300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$717.40
|
| Rate for Payer: First Health Commercial |
$759.60
|
| Rate for Payer: First Health Workers Compensation |
$325.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$759.60
|
| Rate for Payer: GEHA Commercial |
$590.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$759.60
|
| Rate for Payer: Multiplan All |
$768.04
|
| Rate for Payer: OMNI Networks Commercial |
$590.80
|
| Rate for Payer: One Health Plan PPO/POS |
$759.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$801.80
|
| Rate for Payer: Three Rivers Provider Network All |
$633.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$784.92
|
| Rate for Payer: Zelis Auto |
$337.60
|
| Rate for Payer: Zelis Worker's Compensation |
$230.41
|
|
|
REMOVAL OF BREAST TISSUE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
6119300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$7,272.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$506.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$717.40
|
| Rate for Payer: First Health Commercial |
$759.60
|
| Rate for Payer: First Health Workers Compensation |
$325.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$759.60
|
| Rate for Payer: GEHA Commercial |
$675.20
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$759.60
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: Multiplan All |
$768.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: OMNI Networks Commercial |
$590.80
|
| Rate for Payer: One Health Plan PPO/POS |
$759.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$801.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: Three Rivers Provider Network All |
$633.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$784.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Auto |
$337.60
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$230.41
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 23000
|
| Hospital Charge Code |
6123000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$565.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$753.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 23000
|
| Hospital Charge Code |
6123000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$894.90 |
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$659.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
REMOVAL OF CERVIX
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT 57530
|
| Hospital Charge Code |
6157530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$836.00 |
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$748.00
|
| Rate for Payer: First Health Commercial |
$792.00
|
| Rate for Payer: First Health Workers Compensation |
$339.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.00
|
| Rate for Payer: GEHA Commercial |
$616.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.00
|
| Rate for Payer: Multiplan All |
$800.80
|
| Rate for Payer: OMNI Networks Commercial |
$616.00
|
| Rate for Payer: One Health Plan PPO/POS |
$792.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.00
|
| Rate for Payer: Three Rivers Provider Network All |
$660.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$818.40
|
| Rate for Payer: Zelis Auto |
$352.00
|
| Rate for Payer: Zelis Worker's Compensation |
$240.24
|
|
|
REMOVAL OF CERVIX
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT 57530
|
| Hospital Charge Code |
6157530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$748.00
|
| Rate for Payer: First Health Commercial |
$792.00
|
| Rate for Payer: First Health Workers Compensation |
$339.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.00
|
| Rate for Payer: GEHA Commercial |
$704.00
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.00
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$800.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$616.00
|
| Rate for Payer: One Health Plan PPO/POS |
$792.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$660.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$818.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$352.00
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$240.24
|
|
|
REMOVAL OF CERVIX RADICAL
|
Facility
|
IP
|
$3,803.00
|
|
|
Service Code
|
CPT 57531
|
| Hospital Charge Code |
6157531
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,038.22 |
| Max. Negotiated Rate |
$3,612.85 |
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$3,232.55
|
| Rate for Payer: First Health Commercial |
$3,422.70
|
| Rate for Payer: First Health Workers Compensation |
$1,468.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,422.70
|
| Rate for Payer: GEHA Commercial |
$2,662.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,422.70
|
| Rate for Payer: Multiplan All |
$3,460.73
|
| Rate for Payer: OMNI Networks Commercial |
$2,662.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,422.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,612.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,852.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,536.79
|
| Rate for Payer: Zelis Auto |
$1,521.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,038.22
|
|
|
REMOVAL OF CERVIX RADICAL
|
Facility
|
OP
|
$3,803.00
|
|
|
Service Code
|
CPT 57531
|
| Hospital Charge Code |
6157531
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$950.75 |
| Max. Negotiated Rate |
$3,612.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,281.80
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$3,232.55
|
| Rate for Payer: First Health Commercial |
$3,422.70
|
| Rate for Payer: First Health Workers Compensation |
$1,468.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,422.70
|
| Rate for Payer: GEHA Commercial |
$3,042.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,422.70
|
| Rate for Payer: Humana ChoiceCare |
$988.78
|
| Rate for Payer: Multiplan All |
$3,460.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,281.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,662.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,422.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,612.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,852.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,346.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$950.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,536.79
|
| Rate for Payer: Zelis Auto |
$1,521.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,901.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,038.22
|
|
|
REMOVAL OF COLLAR BONE
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT 23125
|
| Hospital Charge Code |
6123125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.67 |
| 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 |
$871.80
|
| 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 |
$871.80
|
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cigna Commercial |
$1,235.05
|
| Rate for Payer: First Health Commercial |
$1,307.70
|
| Rate for Payer: First Health Workers Compensation |
$561.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,307.70
|
| Rate for Payer: GEHA Commercial |
$1,162.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,307.70
|
| 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 |
$1,322.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,017.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,307.70
|
| 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 |
$1,380.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.75
|
| 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 |
$1,351.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$581.20
|
| 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 |
$396.67
|
|
|
REMOVAL OF COLLAR BONE
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT 23125
|
| Hospital Charge Code |
6123125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.67 |
| Max. Negotiated Rate |
$1,380.35 |
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cigna Commercial |
$1,235.05
|
| Rate for Payer: First Health Commercial |
$1,307.70
|
| Rate for Payer: First Health Workers Compensation |
$561.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,307.70
|
| Rate for Payer: GEHA Commercial |
$1,017.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,307.70
|
| Rate for Payer: Multiplan All |
$1,322.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,017.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,307.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,380.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,351.29
|
| Rate for Payer: Zelis Auto |
$581.20
|
| Rate for Payer: Zelis Worker's Compensation |
$396.67
|
|
|
REMOVAL OF COLON
|
Facility
|
OP
|
$2,614.00
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
6144160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$653.50 |
| Max. Negotiated Rate |
$2,483.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,568.40
|
| Rate for Payer: Cash Price |
$1,568.40
|
| Rate for Payer: Cigna Commercial |
$2,221.90
|
| Rate for Payer: First Health Commercial |
$2,352.60
|
| Rate for Payer: First Health Workers Compensation |
$1,009.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,352.60
|
| Rate for Payer: GEHA Commercial |
$2,091.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,352.60
|
| Rate for Payer: Humana ChoiceCare |
$679.64
|
| Rate for Payer: Multiplan All |
$2,378.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,568.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,829.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,352.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,483.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,960.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,300.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$653.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,431.02
|
| Rate for Payer: Zelis Auto |
$1,045.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,307.00
|
| Rate for Payer: Zelis Worker's Compensation |
$713.62
|
|
|
REMOVAL OF COLON
|
Facility
|
OP
|
$3,920.00
|
|
|
Service Code
|
CPT 44150
|
| Hospital Charge Code |
6144150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$3,724.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,352.00
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cigna Commercial |
$3,332.00
|
| Rate for Payer: First Health Commercial |
$3,528.00
|
| Rate for Payer: First Health Workers Compensation |
$1,513.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,528.00
|
| Rate for Payer: GEHA Commercial |
$3,136.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,528.00
|
| Rate for Payer: Humana ChoiceCare |
$1,019.20
|
| Rate for Payer: Multiplan All |
$3,567.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,352.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,744.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,528.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,724.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,940.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,449.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$980.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,645.60
|
| Rate for Payer: Zelis Auto |
$1,568.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,960.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,070.16
|
|
|
REMOVAL OF COLON
|
Facility
|
IP
|
$3,920.00
|
|
|
Service Code
|
CPT 44150
|
| Hospital Charge Code |
6144150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,070.16 |
| Max. Negotiated Rate |
$3,724.00 |
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cigna Commercial |
$3,332.00
|
| Rate for Payer: First Health Commercial |
$3,528.00
|
| Rate for Payer: First Health Workers Compensation |
$1,513.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,528.00
|
| Rate for Payer: GEHA Commercial |
$2,744.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,528.00
|
| Rate for Payer: Multiplan All |
$3,567.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,744.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,528.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,724.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,940.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,645.60
|
| Rate for Payer: Zelis Auto |
$1,568.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,070.16
|
|
|
REMOVAL OF COLON
|
Facility
|
IP
|
$2,614.00
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
6144160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$713.62 |
| Max. Negotiated Rate |
$2,483.30 |
| Rate for Payer: Cash Price |
$1,568.40
|
| Rate for Payer: Cigna Commercial |
$2,221.90
|
| Rate for Payer: First Health Commercial |
$2,352.60
|
| Rate for Payer: First Health Workers Compensation |
$1,009.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,352.60
|
| Rate for Payer: GEHA Commercial |
$1,829.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,352.60
|
| Rate for Payer: Multiplan All |
$2,378.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,829.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,352.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,483.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,960.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,431.02
|
| Rate for Payer: Zelis Auto |
$1,045.60
|
| Rate for Payer: Zelis Worker's Compensation |
$713.62
|
|
|
REMOVAL OF COLON/ILEOSTOMY
|
Facility
|
IP
|
$4,362.00
|
|
|
Service Code
|
CPT 44155
|
| Hospital Charge Code |
6144155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,190.83 |
| Max. Negotiated Rate |
$4,143.90 |
| Rate for Payer: Cash Price |
$2,617.20
|
| Rate for Payer: Cigna Commercial |
$3,707.70
|
| Rate for Payer: First Health Commercial |
$3,925.80
|
| Rate for Payer: First Health Workers Compensation |
$1,684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,925.80
|
| Rate for Payer: GEHA Commercial |
$3,053.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,925.80
|
| Rate for Payer: Multiplan All |
$3,969.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,053.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,925.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,143.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,056.66
|
| Rate for Payer: Zelis Auto |
$1,744.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,190.83
|
|
|
REMOVAL OF COLON/ILEOSTOMY
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
CPT 44156
|
| Hospital Charge Code |
6144156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,206.25 |
| Max. Negotiated Rate |
$4,583.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,895.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cigna Commercial |
$4,101.25
|
| Rate for Payer: First Health Commercial |
$4,342.50
|
| Rate for Payer: First Health Workers Compensation |
$1,862.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,342.50
|
| Rate for Payer: GEHA Commercial |
$3,860.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,342.50
|
| Rate for Payer: Humana ChoiceCare |
$1,254.50
|
| Rate for Payer: Multiplan All |
$4,390.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,895.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,377.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,342.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,583.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,618.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,246.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,487.25
|
| Rate for Payer: Zelis Auto |
$1,930.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,412.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,317.22
|
|
|
REMOVAL OF COLON/ILEOSTOMY
|
Facility
|
OP
|
$4,362.00
|
|
|
Service Code
|
CPT 44155
|
| Hospital Charge Code |
6144155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,090.50 |
| Max. Negotiated Rate |
$4,143.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,617.20
|
| Rate for Payer: Cash Price |
$2,617.20
|
| Rate for Payer: Cigna Commercial |
$3,707.70
|
| Rate for Payer: First Health Commercial |
$3,925.80
|
| Rate for Payer: First Health Workers Compensation |
$1,684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,925.80
|
| Rate for Payer: GEHA Commercial |
$3,489.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,925.80
|
| Rate for Payer: Humana ChoiceCare |
$1,134.12
|
| Rate for Payer: Multiplan All |
$3,969.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,617.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,053.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,925.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,143.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,838.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,090.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,056.66
|
| Rate for Payer: Zelis Auto |
$1,744.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,190.83
|
|
|
REMOVAL OF COLON/ILEOSTOMY
|
Facility
|
OP
|
$4,493.00
|
|
|
Service Code
|
CPT 44151
|
| Hospital Charge Code |
6144151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,123.25 |
| Max. Negotiated Rate |
$4,268.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,695.80
|
| Rate for Payer: Cash Price |
$2,695.80
|
| Rate for Payer: Cigna Commercial |
$3,819.05
|
| Rate for Payer: First Health Commercial |
$4,043.70
|
| Rate for Payer: First Health Workers Compensation |
$1,734.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,043.70
|
| Rate for Payer: GEHA Commercial |
$3,594.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,043.70
|
| Rate for Payer: Humana ChoiceCare |
$1,168.18
|
| Rate for Payer: Multiplan All |
$4,088.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,695.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,145.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,043.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,268.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,369.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,953.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,123.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,178.49
|
| Rate for Payer: Zelis Auto |
$1,797.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,246.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,226.59
|
|
|
REMOVAL OF COLON/ILEOSTOMY
|
Facility
|
IP
|
$4,493.00
|
|
|
Service Code
|
CPT 44151
|
| Hospital Charge Code |
6144151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,226.59 |
| Max. Negotiated Rate |
$4,268.35 |
| Rate for Payer: Cash Price |
$2,695.80
|
| Rate for Payer: Cigna Commercial |
$3,819.05
|
| Rate for Payer: First Health Commercial |
$4,043.70
|
| Rate for Payer: First Health Workers Compensation |
$1,734.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,043.70
|
| Rate for Payer: GEHA Commercial |
$3,145.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,043.70
|
| Rate for Payer: Multiplan All |
$4,088.63
|
| Rate for Payer: OMNI Networks Commercial |
$3,145.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,043.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,268.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,369.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,178.49
|
| Rate for Payer: Zelis Auto |
$1,797.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,226.59
|
|
|
REMOVAL OF COLON/ILEOSTOMY
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
CPT 44156
|
| Hospital Charge Code |
6144156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,317.22 |
| Max. Negotiated Rate |
$4,583.75 |
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cigna Commercial |
$4,101.25
|
| Rate for Payer: First Health Commercial |
$4,342.50
|
| Rate for Payer: First Health Workers Compensation |
$1,862.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,342.50
|
| Rate for Payer: GEHA Commercial |
$3,377.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,342.50
|
| Rate for Payer: Multiplan All |
$4,390.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,377.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,342.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,583.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,618.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,487.25
|
| Rate for Payer: Zelis Auto |
$1,930.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,317.22
|
|
|
REMOVAL OF ELBOW BURSA
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
6124105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.79 |
| 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 |
$529.20
|
| 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 |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cigna Commercial |
$749.70
|
| Rate for Payer: First Health Commercial |
$793.80
|
| Rate for Payer: First Health Workers Compensation |
$340.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$793.80
|
| Rate for Payer: GEHA Commercial |
$705.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$793.80
|
| 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 |
$802.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$617.40
|
| Rate for Payer: One Health Plan PPO/POS |
$793.80
|
| 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 |
$837.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$661.50
|
| 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 |
$820.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$352.80
|
| 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 |
$240.79
|
|
|
REMOVAL OF ELBOW BURSA
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
6124105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$837.90 |
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cigna Commercial |
$749.70
|
| Rate for Payer: First Health Commercial |
$793.80
|
| Rate for Payer: First Health Workers Compensation |
$340.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$793.80
|
| Rate for Payer: GEHA Commercial |
$617.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$793.80
|
| Rate for Payer: Multiplan All |
$802.62
|
| Rate for Payer: OMNI Networks Commercial |
$617.40
|
| Rate for Payer: One Health Plan PPO/POS |
$793.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$837.90
|
| Rate for Payer: Three Rivers Provider Network All |
$661.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$820.26
|
| Rate for Payer: Zelis Auto |
$352.80
|
| Rate for Payer: Zelis Worker's Compensation |
$240.79
|
|
