|
REMOVAL OF ELBOW JOINT
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
CPT 24155
|
| Hospital Charge Code |
6124155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.93 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,041.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$1,475.60
|
| Rate for Payer: First Health Commercial |
$1,562.40
|
| Rate for Payer: First Health Workers Compensation |
$670.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,562.40
|
| Rate for Payer: GEHA Commercial |
$1,388.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,562.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,579.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,215.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,562.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,649.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,614.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$694.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$473.93
|
|
|
REMOVAL OF ELBOW JOINT
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
CPT 24155
|
| Hospital Charge Code |
6124155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.93 |
| Max. Negotiated Rate |
$1,649.20 |
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$1,475.60
|
| Rate for Payer: First Health Commercial |
$1,562.40
|
| Rate for Payer: First Health Workers Compensation |
$670.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,562.40
|
| Rate for Payer: GEHA Commercial |
$1,215.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,562.40
|
| Rate for Payer: Multiplan All |
$1,579.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,215.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,562.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,649.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,614.48
|
| Rate for Payer: Zelis Auto |
$694.40
|
| Rate for Payer: Zelis Worker's Compensation |
$473.93
|
|
|
REMOVAL OF EPIDIDYMIS
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 54860
|
| Hospital Charge Code |
6154860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$234.51 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$515.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$515.40
|
| Rate for Payer: Cash Price |
$515.40
|
| Rate for Payer: Cigna Commercial |
$730.15
|
| Rate for Payer: First Health Commercial |
$773.10
|
| Rate for Payer: First Health Workers Compensation |
$331.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$773.10
|
| Rate for Payer: GEHA Commercial |
$687.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$773.10
|
| 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 |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$781.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$601.30
|
| Rate for Payer: One Health Plan PPO/POS |
$773.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$816.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$644.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$798.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$343.60
|
| 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 |
$234.51
|
|
|
REMOVAL OF EPIDIDYMIS
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 54860
|
| Hospital Charge Code |
6154860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$234.51 |
| Max. Negotiated Rate |
$816.05 |
| Rate for Payer: Cash Price |
$515.40
|
| Rate for Payer: Cigna Commercial |
$730.15
|
| Rate for Payer: First Health Commercial |
$773.10
|
| Rate for Payer: First Health Workers Compensation |
$331.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$773.10
|
| Rate for Payer: GEHA Commercial |
$601.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$773.10
|
| Rate for Payer: Multiplan All |
$781.69
|
| Rate for Payer: OMNI Networks Commercial |
$601.30
|
| Rate for Payer: One Health Plan PPO/POS |
$773.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$816.05
|
| Rate for Payer: Three Rivers Provider Network All |
$644.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$798.87
|
| Rate for Payer: Zelis Auto |
$343.60
|
| Rate for Payer: Zelis Worker's Compensation |
$234.51
|
|
|
REMOVAL OF EPIDIDYMIS
|
Facility
|
OP
|
$1,163.00
|
|
|
Service Code
|
CPT 54861
|
| Hospital Charge Code |
6154861
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.50 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$697.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cigna Commercial |
$988.55
|
| Rate for Payer: First Health Commercial |
$1,046.70
|
| Rate for Payer: First Health Workers Compensation |
$449.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,046.70
|
| Rate for Payer: GEHA Commercial |
$930.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,046.70
|
| 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 |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,058.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$814.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,046.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,104.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$872.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,081.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$465.20
|
| 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 |
$317.50
|
|
|
REMOVAL OF EPIDIDYMIS
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
CPT 54861
|
| Hospital Charge Code |
6154861
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.50 |
| Max. Negotiated Rate |
$1,104.85 |
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cigna Commercial |
$988.55
|
| Rate for Payer: First Health Commercial |
$1,046.70
|
| Rate for Payer: First Health Workers Compensation |
$449.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,046.70
|
| Rate for Payer: GEHA Commercial |
$814.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,046.70
|
| Rate for Payer: Multiplan All |
$1,058.33
|
| Rate for Payer: OMNI Networks Commercial |
$814.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,046.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,104.85
|
| Rate for Payer: Three Rivers Provider Network All |
$872.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,081.59
|
| Rate for Payer: Zelis Auto |
$465.20
|
| Rate for Payer: Zelis Worker's Compensation |
$317.50
|
|
|
REMOVAL OF EPIGLOTTIS
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 31420
|
| Hospital Charge Code |
6131420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.83 |
| Max. Negotiated Rate |
$1,614.05 |
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,444.15
|
| Rate for Payer: First Health Commercial |
$1,529.10
|
| Rate for Payer: First Health Workers Compensation |
$655.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.10
|
| Rate for Payer: GEHA Commercial |
$1,189.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.10
|
| Rate for Payer: Multiplan All |
$1,546.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.07
|
| Rate for Payer: Zelis Auto |
$679.60
|
| Rate for Payer: Zelis Worker's Compensation |
$463.83
|
|
|
REMOVAL OF EPIGLOTTIS
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 31420
|
| Hospital Charge Code |
6131420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.83 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,019.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,444.15
|
| Rate for Payer: First Health Commercial |
$1,529.10
|
| Rate for Payer: First Health Workers Compensation |
$655.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.10
|
| Rate for Payer: GEHA Commercial |
$1,359.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,546.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$679.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$463.83
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$9,610.00
|
|
|
Service Code
|
CPT 43113
|
| Hospital Charge Code |
6143113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,402.50 |
| Max. Negotiated Rate |
$9,129.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,766.00
|
| Rate for Payer: Cash Price |
$5,766.00
|
| Rate for Payer: Cigna Commercial |
$8,168.50
|
| Rate for Payer: First Health Commercial |
$8,649.00
|
| Rate for Payer: First Health Workers Compensation |
$3,710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,649.00
|
| Rate for Payer: GEHA Commercial |
$7,688.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,649.00
|
| Rate for Payer: Humana ChoiceCare |
$2,498.60
|
| Rate for Payer: Multiplan All |
$8,745.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,766.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,727.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,649.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,129.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,207.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,456.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,402.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,937.30
|
| Rate for Payer: Zelis Auto |
$3,844.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,805.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,623.53
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 43112
|
| Hospital Charge Code |
6143112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,562.11 |
| Max. Negotiated Rate |
$5,435.90 |
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cigna Commercial |
$4,863.70
|
| Rate for Payer: First Health Commercial |
$5,149.80
|
| Rate for Payer: First Health Workers Compensation |
$2,209.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,149.80
|
| Rate for Payer: GEHA Commercial |
$4,005.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,149.80
|
| Rate for Payer: Multiplan All |
$5,207.02
|
| Rate for Payer: OMNI Networks Commercial |
$4,005.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,149.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,435.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,291.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,321.46
|
| Rate for Payer: Zelis Auto |
$2,288.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,562.11
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$9,717.00
|
|
|
Service Code
|
CPT 43108
|
| Hospital Charge Code |
6143108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,652.74 |
| Max. Negotiated Rate |
$9,231.15 |
| Rate for Payer: Cash Price |
$5,830.20
|
| Rate for Payer: Cigna Commercial |
$8,259.45
|
| Rate for Payer: First Health Commercial |
$8,745.30
|
| Rate for Payer: First Health Workers Compensation |
$3,751.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,745.30
|
| Rate for Payer: GEHA Commercial |
$6,801.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,745.30
|
| Rate for Payer: Multiplan All |
$8,842.47
|
| Rate for Payer: OMNI Networks Commercial |
$6,801.90
|
| Rate for Payer: One Health Plan PPO/POS |
$8,745.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,231.15
|
| Rate for Payer: Three Rivers Provider Network All |
$7,287.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,036.81
|
| Rate for Payer: Zelis Auto |
$3,886.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,652.74
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$9,717.00
|
|
|
Service Code
|
CPT 43108
|
| Hospital Charge Code |
6143108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,429.25 |
| Max. Negotiated Rate |
$9,231.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,830.20
|
| Rate for Payer: Cash Price |
$5,830.20
|
| Rate for Payer: Cigna Commercial |
$8,259.45
|
| Rate for Payer: First Health Commercial |
$8,745.30
|
| Rate for Payer: First Health Workers Compensation |
$3,751.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,745.30
|
| Rate for Payer: GEHA Commercial |
$7,773.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,745.30
|
| Rate for Payer: Humana ChoiceCare |
$2,526.42
|
| Rate for Payer: Multiplan All |
$8,842.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,830.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,801.90
|
| Rate for Payer: One Health Plan PPO/POS |
$8,745.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,231.15
|
| Rate for Payer: Three Rivers Provider Network All |
$7,287.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,550.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,429.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,036.81
|
| Rate for Payer: Zelis Auto |
$3,886.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,858.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,652.74
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$5,411.00
|
|
|
Service Code
|
CPT 43107
|
| Hospital Charge Code |
6143107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,352.75 |
| Max. Negotiated Rate |
$5,140.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,246.60
|
| Rate for Payer: Cash Price |
$3,246.60
|
| Rate for Payer: Cigna Commercial |
$4,599.35
|
| Rate for Payer: First Health Commercial |
$4,869.90
|
| Rate for Payer: First Health Workers Compensation |
$2,089.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,869.90
|
| Rate for Payer: GEHA Commercial |
$4,328.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,869.90
|
| Rate for Payer: Humana ChoiceCare |
$1,406.86
|
| Rate for Payer: Multiplan All |
$4,924.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,246.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,787.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,869.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,140.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,058.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,761.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,352.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,032.23
|
| Rate for Payer: Zelis Auto |
$2,164.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,705.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,477.20
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 43112
|
| Hospital Charge Code |
6143112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,430.50 |
| Max. Negotiated Rate |
$5,435.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,433.20
|
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cigna Commercial |
$4,863.70
|
| Rate for Payer: First Health Commercial |
$5,149.80
|
| Rate for Payer: First Health Workers Compensation |
$2,209.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,149.80
|
| Rate for Payer: GEHA Commercial |
$4,577.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,149.80
|
| Rate for Payer: Humana ChoiceCare |
$1,487.72
|
| Rate for Payer: Multiplan All |
$5,207.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,433.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,005.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,149.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,435.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,291.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,035.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,321.46
|
| Rate for Payer: Zelis Auto |
$2,288.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,861.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,562.11
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$9,610.00
|
|
|
Service Code
|
CPT 43113
|
| Hospital Charge Code |
6143113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,623.53 |
| Max. Negotiated Rate |
$9,129.50 |
| Rate for Payer: Cash Price |
$5,766.00
|
| Rate for Payer: Cigna Commercial |
$8,168.50
|
| Rate for Payer: First Health Commercial |
$8,649.00
|
| Rate for Payer: First Health Workers Compensation |
$3,710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,649.00
|
| Rate for Payer: GEHA Commercial |
$6,727.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,649.00
|
| Rate for Payer: Multiplan All |
$8,745.10
|
| Rate for Payer: OMNI Networks Commercial |
$6,727.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,649.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,129.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,207.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,937.30
|
| Rate for Payer: Zelis Auto |
$3,844.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,623.53
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$5,411.00
|
|
|
Service Code
|
CPT 43107
|
| Hospital Charge Code |
6143107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,477.20 |
| Max. Negotiated Rate |
$5,140.45 |
| Rate for Payer: Cash Price |
$3,246.60
|
| Rate for Payer: Cigna Commercial |
$4,599.35
|
| Rate for Payer: First Health Commercial |
$4,869.90
|
| Rate for Payer: First Health Workers Compensation |
$2,089.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,869.90
|
| Rate for Payer: GEHA Commercial |
$3,787.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,869.90
|
| Rate for Payer: Multiplan All |
$4,924.01
|
| Rate for Payer: OMNI Networks Commercial |
$3,787.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,869.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,140.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,058.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,032.23
|
| Rate for Payer: Zelis Auto |
$2,164.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,477.20
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$8,136.00
|
|
|
Service Code
|
CPT 43124
|
| Hospital Charge Code |
6143124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,729.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,881.60
|
| Rate for Payer: Cash Price |
$4,881.60
|
| Rate for Payer: Cigna Commercial |
$6,915.60
|
| Rate for Payer: First Health Commercial |
$7,322.40
|
| Rate for Payer: First Health Workers Compensation |
$3,141.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,322.40
|
| Rate for Payer: GEHA Commercial |
$6,508.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,322.40
|
| Rate for Payer: Humana ChoiceCare |
$2,115.36
|
| Rate for Payer: Multiplan All |
$7,403.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,881.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,695.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,322.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,729.20
|
| Rate for Payer: Three Rivers Provider Network All |
$6,102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,159.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,034.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,566.48
|
| Rate for Payer: Zelis Auto |
$3,254.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,068.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,221.13
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$8,136.00
|
|
|
Service Code
|
CPT 43124
|
| Hospital Charge Code |
6143124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,221.13 |
| Max. Negotiated Rate |
$7,729.20 |
| Rate for Payer: Cash Price |
$4,881.60
|
| Rate for Payer: Cigna Commercial |
$6,915.60
|
| Rate for Payer: First Health Commercial |
$7,322.40
|
| Rate for Payer: First Health Workers Compensation |
$3,141.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,322.40
|
| Rate for Payer: GEHA Commercial |
$5,695.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,322.40
|
| Rate for Payer: Multiplan All |
$7,403.76
|
| Rate for Payer: OMNI Networks Commercial |
$5,695.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,322.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,729.20
|
| Rate for Payer: Three Rivers Provider Network All |
$6,102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,566.48
|
| Rate for Payer: Zelis Auto |
$3,254.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,221.13
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Facility
|
IP
|
$3,148.00
|
|
|
Service Code
|
CPT 43135
|
| Hospital Charge Code |
6143135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$859.40 |
| Max. Negotiated Rate |
$2,990.60 |
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cigna Commercial |
$2,675.80
|
| Rate for Payer: First Health Commercial |
$2,833.20
|
| Rate for Payer: First Health Workers Compensation |
$1,215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,833.20
|
| Rate for Payer: GEHA Commercial |
$2,203.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,833.20
|
| Rate for Payer: Multiplan All |
$2,864.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,203.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,833.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,990.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,361.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,927.64
|
| Rate for Payer: Zelis Auto |
$1,259.20
|
| Rate for Payer: Zelis Worker's Compensation |
$859.40
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 43130
|
| Hospital Charge Code |
6143130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.72 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,394.00
|
| Rate for Payer: First Health Commercial |
$1,476.00
|
| Rate for Payer: First Health Workers Compensation |
$633.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.00
|
| Rate for Payer: GEHA Commercial |
$1,312.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,492.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,525.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$656.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$447.72
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Facility
|
OP
|
$3,148.00
|
|
|
Service Code
|
CPT 43135
|
| Hospital Charge Code |
6143135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$787.00 |
| Max. Negotiated Rate |
$2,990.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cigna Commercial |
$2,675.80
|
| Rate for Payer: First Health Commercial |
$2,833.20
|
| Rate for Payer: First Health Workers Compensation |
$1,215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,833.20
|
| Rate for Payer: GEHA Commercial |
$2,518.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,833.20
|
| Rate for Payer: Humana ChoiceCare |
$818.48
|
| Rate for Payer: Multiplan All |
$2,864.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,888.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,203.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,833.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,990.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,361.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,770.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$787.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,927.64
|
| Rate for Payer: Zelis Auto |
$1,259.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,574.00
|
| Rate for Payer: Zelis Worker's Compensation |
$859.40
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 43130
|
| Hospital Charge Code |
6143130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.72 |
| Max. Negotiated Rate |
$1,558.00 |
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,394.00
|
| Rate for Payer: First Health Commercial |
$1,476.00
|
| Rate for Payer: First Health Workers Compensation |
$633.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.00
|
| Rate for Payer: GEHA Commercial |
$1,148.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.00
|
| Rate for Payer: Multiplan All |
$1,492.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,525.20
|
| Rate for Payer: Zelis Auto |
$656.00
|
| Rate for Payer: Zelis Worker's Compensation |
$447.72
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 31200
|
| Hospital Charge Code |
6131200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$785.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 31200
|
| Hospital Charge Code |
6131200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$897.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
OP
|
$1,783.00
|
|
|
Service Code
|
CPT 31205
|
| Hospital Charge Code |
6131205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,069.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$1,515.55
|
| Rate for Payer: First Health Commercial |
$1,604.70
|
| Rate for Payer: First Health Workers Compensation |
$688.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,604.70
|
| Rate for Payer: GEHA Commercial |
$1,426.40
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,604.70
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,622.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,248.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,604.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,693.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,337.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,658.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$713.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$486.76
|
|
