|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
6128090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.31 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$471.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$667.25
|
| Rate for Payer: First Health Commercial |
$706.50
|
| Rate for Payer: First Health Workers Compensation |
$303.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$706.50
|
| Rate for Payer: GEHA Commercial |
$628.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$706.50
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$714.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$549.50
|
| Rate for Payer: One Health Plan PPO/POS |
$706.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$745.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$588.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$314.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$214.31
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
6128104
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$765.00
|
| Rate for Payer: First Health Commercial |
$810.00
|
| Rate for Payer: First Health Workers Compensation |
$347.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.00
|
| Rate for Payer: GEHA Commercial |
$630.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.00
|
| Rate for Payer: Multiplan All |
$819.00
|
| Rate for Payer: OMNI Networks Commercial |
$630.00
|
| Rate for Payer: One Health Plan PPO/POS |
$810.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.00
|
| Rate for Payer: Three Rivers Provider Network All |
$675.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.00
|
| Rate for Payer: Zelis Auto |
$360.00
|
| Rate for Payer: Zelis Worker's Compensation |
$245.70
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
6128090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.31 |
| Max. Negotiated Rate |
$745.75 |
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$667.25
|
| Rate for Payer: First Health Commercial |
$706.50
|
| Rate for Payer: First Health Workers Compensation |
$303.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$706.50
|
| Rate for Payer: GEHA Commercial |
$549.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$706.50
|
| Rate for Payer: Multiplan All |
$714.35
|
| Rate for Payer: OMNI Networks Commercial |
$549.50
|
| Rate for Payer: One Health Plan PPO/POS |
$706.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$745.75
|
| Rate for Payer: Three Rivers Provider Network All |
$588.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.05
|
| Rate for Payer: Zelis Auto |
$314.00
|
| Rate for Payer: Zelis Worker's Compensation |
$214.31
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
6128104
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$765.00
|
| Rate for Payer: First Health Commercial |
$810.00
|
| Rate for Payer: First Health Workers Compensation |
$347.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.00
|
| Rate for Payer: GEHA Commercial |
$720.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$819.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$630.00
|
| Rate for Payer: One Health Plan PPO/POS |
$810.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$675.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$360.00
|
| 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 |
$245.70
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
6128080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$741.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
6128080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$648.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
REMOVAL OF FOREARM LESION
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 25120
|
| Hospital Charge Code |
6125120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.18 |
| 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 |
$604.80
|
| 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 |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: First Health Commercial |
$907.20
|
| Rate for Payer: First Health Workers Compensation |
$389.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$907.20
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$907.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$917.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$705.60
|
| Rate for Payer: One Health Plan PPO/POS |
$907.20
|
| 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 |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$756.00
|
| 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 |
$937.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$403.20
|
| 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 |
$275.18
|
|
|
REMOVAL OF FOREARM LESION
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 25120
|
| Hospital Charge Code |
6125120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.18 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: First Health Commercial |
$907.20
|
| Rate for Payer: First Health Workers Compensation |
$389.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$907.20
|
| Rate for Payer: GEHA Commercial |
$705.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$907.20
|
| Rate for Payer: Multiplan All |
$917.28
|
| Rate for Payer: OMNI Networks Commercial |
$705.60
|
| Rate for Payer: One Health Plan PPO/POS |
$907.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$957.60
|
| Rate for Payer: Three Rivers Provider Network All |
$756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$937.44
|
| Rate for Payer: Zelis Auto |
$403.20
|
| Rate for Payer: Zelis Worker's Compensation |
$275.18
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
OP
|
$3,013.00
|
|
|
Service Code
|
CPT 31081
|
| Hospital Charge Code |
6131081
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.55 |
| 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 |
$1,807.80
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,807.80
|
| Rate for Payer: Cash Price |
$1,807.80
|
| Rate for Payer: Cigna Commercial |
$2,561.05
|
| Rate for Payer: First Health Commercial |
$2,711.70
|
| Rate for Payer: First Health Workers Compensation |
$1,163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,711.70
|
| Rate for Payer: GEHA Commercial |
$2,410.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,711.70
|
| 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 |
$2,741.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,109.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,711.70
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,862.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,259.75
|
| 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 |
$2,802.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,205.20
|
| 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 |
$822.55
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT 31087
|
| Hospital Charge Code |
6131087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$600.60 |
| 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 |
$1,320.00
|
| 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 |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$1,870.00
|
| Rate for Payer: First Health Commercial |
$1,980.00
|
| Rate for Payer: First Health Workers Compensation |
$849.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,980.00
|
| Rate for Payer: GEHA Commercial |
$1,760.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,980.00
|
| 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 |
$2,002.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,540.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,980.00
|
| 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 |
$2,090.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,650.00
|
| 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 |
$2,046.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$880.00
|
| 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 |
$600.60
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
IP
|
$2,278.00
|
|
|
Service Code
|
CPT 31086
|
| Hospital Charge Code |
6131086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$621.89 |
| Max. Negotiated Rate |
$2,164.10 |
| Rate for Payer: Cash Price |
$1,366.80
|
| Rate for Payer: Cigna Commercial |
$1,936.30
|
| Rate for Payer: First Health Commercial |
$2,050.20
|
| Rate for Payer: First Health Workers Compensation |
$879.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,050.20
|
| Rate for Payer: GEHA Commercial |
$1,594.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,050.20
|
| Rate for Payer: Multiplan All |
$2,072.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,594.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,050.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,164.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,708.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,118.54
|
| Rate for Payer: Zelis Auto |
$911.20
|
| Rate for Payer: Zelis Worker's Compensation |
$621.89
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT 31087
|
| Hospital Charge Code |
6131087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,090.00 |
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$1,870.00
|
| Rate for Payer: First Health Commercial |
$1,980.00
|
| Rate for Payer: First Health Workers Compensation |
$849.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,980.00
|
| Rate for Payer: GEHA Commercial |
$1,540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,980.00
|
| Rate for Payer: Multiplan All |
$2,002.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,540.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,980.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,090.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,650.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,046.00
|
| Rate for Payer: Zelis Auto |
$880.00
|
| Rate for Payer: Zelis Worker's Compensation |
$600.60
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
CPT 31084
|
| Hospital Charge Code |
6131084
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$639.37 |
| 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 |
$1,405.20
|
| 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 |
$1,405.20
|
| Rate for Payer: Cash Price |
$1,405.20
|
| Rate for Payer: Cigna Commercial |
$1,990.70
|
| Rate for Payer: First Health Commercial |
$2,107.80
|
| Rate for Payer: First Health Workers Compensation |
$904.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,107.80
|
| Rate for Payer: GEHA Commercial |
$1,873.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,107.80
|
| 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 |
$2,131.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,639.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,107.80
|
| 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 |
$2,224.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,756.50
|
| 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 |
$2,178.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$936.80
|
| 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 |
$639.37
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
CPT 31084
|
| Hospital Charge Code |
6131084
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$639.37 |
| Max. Negotiated Rate |
$2,224.90 |
| Rate for Payer: Cash Price |
$1,405.20
|
| Rate for Payer: Cigna Commercial |
$1,990.70
|
| Rate for Payer: First Health Commercial |
$2,107.80
|
| Rate for Payer: First Health Workers Compensation |
$904.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,107.80
|
| Rate for Payer: GEHA Commercial |
$1,639.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,107.80
|
| Rate for Payer: Multiplan All |
$2,131.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,639.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,107.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,224.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,756.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,178.06
|
| Rate for Payer: Zelis Auto |
$936.80
|
| Rate for Payer: Zelis Worker's Compensation |
$639.37
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
OP
|
$2,278.00
|
|
|
Service Code
|
CPT 31086
|
| Hospital Charge Code |
6131086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$621.89 |
| 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 |
$1,366.80
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,366.80
|
| Rate for Payer: Cash Price |
$1,366.80
|
| Rate for Payer: Cigna Commercial |
$1,936.30
|
| Rate for Payer: First Health Commercial |
$2,050.20
|
| Rate for Payer: First Health Workers Compensation |
$879.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,050.20
|
| Rate for Payer: GEHA Commercial |
$1,822.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,050.20
|
| 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 |
$2,072.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,594.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,050.20
|
| 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 |
$2,164.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,708.50
|
| 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 |
$2,118.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$911.20
|
| 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 |
$621.89
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
IP
|
$3,222.00
|
|
|
Service Code
|
CPT 31085
|
| Hospital Charge Code |
6131085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$879.61 |
| Max. Negotiated Rate |
$3,060.90 |
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cigna Commercial |
$2,738.70
|
| Rate for Payer: First Health Commercial |
$2,899.80
|
| Rate for Payer: First Health Workers Compensation |
$1,244.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,899.80
|
| Rate for Payer: GEHA Commercial |
$2,255.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,899.80
|
| Rate for Payer: Multiplan All |
$2,932.02
|
| Rate for Payer: OMNI Networks Commercial |
$2,255.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,899.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,060.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,416.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,996.46
|
| Rate for Payer: Zelis Auto |
$1,288.80
|
| Rate for Payer: Zelis Worker's Compensation |
$879.61
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
IP
|
$3,013.00
|
|
|
Service Code
|
CPT 31081
|
| Hospital Charge Code |
6131081
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.55 |
| Max. Negotiated Rate |
$2,862.35 |
| Rate for Payer: Cash Price |
$1,807.80
|
| Rate for Payer: Cigna Commercial |
$2,561.05
|
| Rate for Payer: First Health Commercial |
$2,711.70
|
| Rate for Payer: First Health Workers Compensation |
$1,163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,711.70
|
| Rate for Payer: GEHA Commercial |
$2,109.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,711.70
|
| Rate for Payer: Multiplan All |
$2,741.83
|
| Rate for Payer: OMNI Networks Commercial |
$2,109.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,711.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,862.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,259.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,802.09
|
| Rate for Payer: Zelis Auto |
$1,205.20
|
| Rate for Payer: Zelis Worker's Compensation |
$822.55
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
CPT 31080
|
| Hospital Charge Code |
6131080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$570.57 |
| Max. Negotiated Rate |
$1,985.50 |
| Rate for Payer: Cash Price |
$1,254.00
|
| Rate for Payer: Cigna Commercial |
$1,776.50
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: First Health Workers Compensation |
$806.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,881.00
|
| Rate for Payer: GEHA Commercial |
$1,463.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,881.00
|
| Rate for Payer: Multiplan All |
$1,901.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,463.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,881.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,985.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,567.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,943.70
|
| Rate for Payer: Zelis Auto |
$836.00
|
| Rate for Payer: Zelis Worker's Compensation |
$570.57
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
OP
|
$3,222.00
|
|
|
Service Code
|
CPT 31085
|
| Hospital Charge Code |
6131085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$879.61 |
| 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 |
$1,933.20
|
| 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 |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cigna Commercial |
$2,738.70
|
| Rate for Payer: First Health Commercial |
$2,899.80
|
| Rate for Payer: First Health Workers Compensation |
$1,244.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,899.80
|
| Rate for Payer: GEHA Commercial |
$2,577.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,899.80
|
| 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 |
$2,932.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,255.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,899.80
|
| 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 |
$3,060.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,416.50
|
| 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 |
$2,996.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,288.80
|
| 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 |
$879.61
|
|
|
REMOVAL OF FRONTAL SINUS
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
CPT 31080
|
| Hospital Charge Code |
6131080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$570.57 |
| 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 |
$1,254.00
|
| 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 |
$1,254.00
|
| Rate for Payer: Cash Price |
$1,254.00
|
| Rate for Payer: Cigna Commercial |
$1,776.50
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: First Health Workers Compensation |
$806.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,881.00
|
| Rate for Payer: GEHA Commercial |
$1,672.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,881.00
|
| 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 |
$1,901.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,463.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,881.00
|
| 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 |
$1,985.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,567.50
|
| 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 |
$1,943.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$836.00
|
| 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 |
$570.57
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
CPT 47620
|
| Hospital Charge Code |
6147620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$725.00 |
| Max. Negotiated Rate |
$2,755.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,740.00
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cigna Commercial |
$2,465.00
|
| Rate for Payer: First Health Commercial |
$2,610.00
|
| Rate for Payer: First Health Workers Compensation |
$1,119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,610.00
|
| Rate for Payer: GEHA Commercial |
$2,320.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,610.00
|
| Rate for Payer: Humana ChoiceCare |
$754.00
|
| Rate for Payer: Multiplan All |
$2,639.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,740.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,030.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,610.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,755.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,175.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,552.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$725.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,697.00
|
| Rate for Payer: Zelis Auto |
$1,160.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,450.00
|
| Rate for Payer: Zelis Worker's Compensation |
$791.70
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
IP
|
$2,363.00
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
6147605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$645.10 |
| Max. Negotiated Rate |
$2,244.85 |
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cigna Commercial |
$2,008.55
|
| Rate for Payer: First Health Commercial |
$2,126.70
|
| Rate for Payer: First Health Workers Compensation |
$912.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,126.70
|
| Rate for Payer: GEHA Commercial |
$1,654.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,126.70
|
| Rate for Payer: Multiplan All |
$2,150.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,654.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,126.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,244.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,772.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,197.59
|
| Rate for Payer: Zelis Auto |
$945.20
|
| Rate for Payer: Zelis Worker's Compensation |
$645.10
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
CPT 47612
|
| Hospital Charge Code |
6147612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$669.00 |
| Max. Negotiated Rate |
$2,542.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cigna Commercial |
$2,274.60
|
| Rate for Payer: First Health Commercial |
$2,408.40
|
| Rate for Payer: First Health Workers Compensation |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,408.40
|
| Rate for Payer: GEHA Commercial |
$2,140.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,408.40
|
| Rate for Payer: Humana ChoiceCare |
$695.76
|
| Rate for Payer: Multiplan All |
$2,435.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,605.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,873.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,408.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,542.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,007.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,354.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$669.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,488.68
|
| Rate for Payer: Zelis Auto |
$1,070.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,338.00
|
| Rate for Payer: Zelis Worker's Compensation |
$730.55
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
OP
|
$2,642.00
|
|
|
Service Code
|
CPT 47610
|
| Hospital Charge Code |
6147610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$660.50 |
| Max. Negotiated Rate |
$2,509.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,585.20
|
| Rate for Payer: Cash Price |
$1,585.20
|
| Rate for Payer: Cigna Commercial |
$2,245.70
|
| Rate for Payer: First Health Commercial |
$2,377.80
|
| Rate for Payer: First Health Workers Compensation |
$1,020.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,377.80
|
| Rate for Payer: GEHA Commercial |
$2,113.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,377.80
|
| Rate for Payer: Humana ChoiceCare |
$686.92
|
| Rate for Payer: Multiplan All |
$2,404.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,585.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,849.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,377.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,509.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,981.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,324.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$660.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,457.06
|
| Rate for Payer: Zelis Auto |
$1,056.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,321.00
|
| Rate for Payer: Zelis Worker's Compensation |
$721.27
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
CPT 47612
|
| Hospital Charge Code |
6147612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$730.55 |
| Max. Negotiated Rate |
$2,542.20 |
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cigna Commercial |
$2,274.60
|
| Rate for Payer: First Health Commercial |
$2,408.40
|
| Rate for Payer: First Health Workers Compensation |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,408.40
|
| Rate for Payer: GEHA Commercial |
$1,873.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,408.40
|
| Rate for Payer: Multiplan All |
$2,435.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,873.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,408.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,542.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,007.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,488.68
|
| Rate for Payer: Zelis Auto |
$1,070.40
|
| Rate for Payer: Zelis Worker's Compensation |
$730.55
|
|
