|
REMOVAL OF METATARSAL HEADS
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 28114
|
| Hospital Charge Code |
6128114
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$466.56 |
| Max. Negotiated Rate |
$1,623.55 |
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cigna Commercial |
$1,452.65
|
| Rate for Payer: First Health Commercial |
$1,538.10
|
| Rate for Payer: First Health Workers Compensation |
$659.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,538.10
|
| Rate for Payer: GEHA Commercial |
$1,196.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,538.10
|
| Rate for Payer: Multiplan All |
$1,555.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,196.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,538.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,623.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,281.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,589.37
|
| Rate for Payer: Zelis Auto |
$683.60
|
| Rate for Payer: Zelis Worker's Compensation |
$466.56
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
IP
|
$1,746.00
|
|
|
Service Code
|
CPT 64790
|
| Hospital Charge Code |
6164790
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$476.66 |
| Max. Negotiated Rate |
$1,658.70 |
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,571.40
|
| Rate for Payer: First Health Workers Compensation |
$674.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,571.40
|
| Rate for Payer: GEHA Commercial |
$1,222.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,571.40
|
| Rate for Payer: Multiplan All |
$1,588.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,222.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,571.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,658.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,309.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,623.78
|
| Rate for Payer: Zelis Auto |
$698.40
|
| Rate for Payer: Zelis Worker's Compensation |
$476.66
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
OP
|
$2,546.00
|
|
|
Service Code
|
CPT 64792
|
| Hospital Charge Code |
6164792
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$695.06 |
| Max. Negotiated Rate |
$12,410.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,527.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,986.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,205.42
|
| Rate for Payer: Cash Price |
$1,527.60
|
| Rate for Payer: Cash Price |
$1,527.60
|
| Rate for Payer: Cigna Commercial |
$2,164.10
|
| Rate for Payer: First Health Commercial |
$2,291.40
|
| Rate for Payer: First Health Workers Compensation |
$983.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,291.40
|
| Rate for Payer: GEHA Commercial |
$2,036.80
|
| Rate for Payer: GEHA Medicare |
$6,205.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,291.40
|
| Rate for Payer: Humana ChoiceCare |
$6,825.96
|
| Rate for Payer: Humana Medicare Advantage |
$6,205.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,425.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,205.42
|
| Rate for Payer: Multiplan All |
$2,316.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,549.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,782.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,291.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,205.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,418.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,410.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,909.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,081.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,205.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,367.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,205.42
|
| Rate for Payer: Zelis Auto |
$1,018.40
|
| Rate for Payer: Zelis Medicare |
$5,274.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,446.50
|
| Rate for Payer: Zelis Worker's Compensation |
$695.06
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
IP
|
$2,546.00
|
|
|
Service Code
|
CPT 64792
|
| Hospital Charge Code |
6164792
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$695.06 |
| Max. Negotiated Rate |
$2,418.70 |
| Rate for Payer: Cash Price |
$1,527.60
|
| Rate for Payer: Cigna Commercial |
$2,164.10
|
| Rate for Payer: First Health Commercial |
$2,291.40
|
| Rate for Payer: First Health Workers Compensation |
$983.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,291.40
|
| Rate for Payer: GEHA Commercial |
$1,782.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,291.40
|
| Rate for Payer: Multiplan All |
$2,316.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,782.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,291.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,418.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,909.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,367.78
|
| Rate for Payer: Zelis Auto |
$1,018.40
|
| Rate for Payer: Zelis Worker's Compensation |
$695.06
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
OP
|
$1,746.00
|
|
|
Service Code
|
CPT 64790
|
| Hospital Charge Code |
6164790
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$476.66 |
| Max. Negotiated Rate |
$3,784.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,892.20
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,571.40
|
| Rate for Payer: First Health Workers Compensation |
$674.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,571.40
|
| Rate for Payer: GEHA Commercial |
$1,396.80
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,571.40
|
| Rate for Payer: Humana ChoiceCare |
$2,081.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,178.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,892.20
|
| Rate for Payer: Multiplan All |
$1,588.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,222.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,571.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,658.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,309.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,892.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,623.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$698.40
|
| Rate for Payer: Zelis Medicare |
$1,608.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,270.64
|
| Rate for Payer: Zelis Worker's Compensation |
$476.66
|
|
|
REMOVAL OF NOSE
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT 30160
|
| Hospital Charge Code |
6130160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.70 |
| Max. Negotiated Rate |
$1,484.85 |
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cigna Commercial |
$1,328.55
|
| Rate for Payer: First Health Commercial |
$1,406.70
|
| Rate for Payer: First Health Workers Compensation |
$603.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,406.70
|
| Rate for Payer: GEHA Commercial |
$1,094.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,406.70
|
| Rate for Payer: Multiplan All |
$1,422.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,406.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,484.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,172.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,453.59
|
| Rate for Payer: Zelis Auto |
$625.20
|
| Rate for Payer: Zelis Worker's Compensation |
$426.70
|
|
|
REMOVAL OF NOSE
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT 30160
|
| Hospital Charge Code |
6130160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.70 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$937.80
|
| 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 |
$5,732.16
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cigna Commercial |
$1,328.55
|
| Rate for Payer: First Health Commercial |
$1,406.70
|
| Rate for Payer: First Health Workers Compensation |
$603.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,406.70
|
| Rate for Payer: GEHA Commercial |
$1,250.40
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,406.70
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,422.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,406.70
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,484.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,172.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,453.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$625.20
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$426.70
|
|
|
REMOVAL OF NOSE LESION
|
Facility
|
OP
|
$1,226.00
|
|
|
Service Code
|
CPT 30125
|
| Hospital Charge Code |
6130125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.70 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$735.60
|
| 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 |
$5,732.16
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cigna Commercial |
$1,042.10
|
| Rate for Payer: First Health Commercial |
$1,103.40
|
| Rate for Payer: First Health Workers Compensation |
$473.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.40
|
| Rate for Payer: GEHA Commercial |
$980.80
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.40
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,115.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$858.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.40
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,164.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$919.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$490.40
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$334.70
|
|
|
REMOVAL OF NOSE LESION
|
Facility
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 30124
|
| Hospital Charge Code |
6130124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.01 |
| Max. Negotiated Rate |
$2,870.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$430.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,435.33
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$610.30
|
| Rate for Payer: First Health Commercial |
$646.20
|
| Rate for Payer: First Health Workers Compensation |
$277.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$646.20
|
| Rate for Payer: GEHA Commercial |
$574.40
|
| Rate for Payer: GEHA Medicare |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$646.20
|
| Rate for Payer: Humana ChoiceCare |
$1,578.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,411.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$653.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| Rate for Payer: OMNI Networks Commercial |
$502.60
|
| Rate for Payer: One Health Plan PPO/POS |
$646.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$682.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$538.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$667.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$287.20
|
| Rate for Payer: Zelis Medicare |
$1,220.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$196.01
|
|
|
REMOVAL OF NOSE LESION
|
Facility
|
IP
|
$1,226.00
|
|
|
Service Code
|
CPT 30125
|
| Hospital Charge Code |
6130125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.70 |
| Max. Negotiated Rate |
$1,164.70 |
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cigna Commercial |
$1,042.10
|
| Rate for Payer: First Health Commercial |
$1,103.40
|
| Rate for Payer: First Health Workers Compensation |
$473.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.40
|
| Rate for Payer: GEHA Commercial |
$858.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.40
|
| Rate for Payer: Multiplan All |
$1,115.66
|
| Rate for Payer: OMNI Networks Commercial |
$858.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,164.70
|
| Rate for Payer: Three Rivers Provider Network All |
$919.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.18
|
| Rate for Payer: Zelis Auto |
$490.40
|
| Rate for Payer: Zelis Worker's Compensation |
$334.70
|
|
|
REMOVAL OF NOSE LESION
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 30124
|
| Hospital Charge Code |
6130124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.01 |
| Max. Negotiated Rate |
$682.10 |
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$610.30
|
| Rate for Payer: First Health Commercial |
$646.20
|
| Rate for Payer: First Health Workers Compensation |
$277.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$646.20
|
| Rate for Payer: GEHA Commercial |
$502.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$646.20
|
| Rate for Payer: Multiplan All |
$653.38
|
| Rate for Payer: OMNI Networks Commercial |
$502.60
|
| Rate for Payer: One Health Plan PPO/POS |
$646.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$682.10
|
| Rate for Payer: Three Rivers Provider Network All |
$538.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$667.74
|
| Rate for Payer: Zelis Auto |
$287.20
|
| Rate for Payer: Zelis Worker's Compensation |
$196.01
|
|
|
REMOVAL OF NOSE POLYP(S)
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
6130110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$277.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
REMOVAL OF NOSE POLYP(S)
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 30115
|
| Hospital Charge Code |
6130115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.42 |
| Max. Negotiated Rate |
$6,284.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,142.47
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$692.80
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
REMOVAL OF NOSE POLYP(S)
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 30115
|
| Hospital Charge Code |
6130115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.42 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$606.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
REMOVAL OF NOSE POLYP(S)
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
6130110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$2,870.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,435.33
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$317.60
|
| Rate for Payer: GEHA Medicare |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Humana ChoiceCare |
$1,578.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,411.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Medicare |
$1,220.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
REMOVAL OF OMENTUM
|
Facility
|
OP
|
$1,652.00
|
|
|
Service Code
|
CPT 49255
|
| Hospital Charge Code |
6149255
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cigna Commercial |
$1,404.20
|
| Rate for Payer: First Health Commercial |
$1,486.80
|
| Rate for Payer: First Health Workers Compensation |
$637.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,486.80
|
| Rate for Payer: GEHA Commercial |
$1,321.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,486.80
|
| Rate for Payer: Humana ChoiceCare |
$429.52
|
| Rate for Payer: Multiplan All |
$1,503.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$991.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,156.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,486.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,569.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,239.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,453.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$413.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,536.36
|
| Rate for Payer: Zelis Auto |
$660.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$826.00
|
| Rate for Payer: Zelis Worker's Compensation |
$451.00
|
|
|
REMOVAL OF OMENTUM
|
Facility
|
IP
|
$1,652.00
|
|
|
Service Code
|
CPT 49255
|
| Hospital Charge Code |
6149255
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cigna Commercial |
$1,404.20
|
| Rate for Payer: First Health Commercial |
$1,486.80
|
| Rate for Payer: First Health Workers Compensation |
$637.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,486.80
|
| Rate for Payer: GEHA Commercial |
$1,156.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,486.80
|
| Rate for Payer: Multiplan All |
$1,503.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,156.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,486.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,569.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,239.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,536.36
|
| Rate for Payer: Zelis Auto |
$660.80
|
| Rate for Payer: Zelis Worker's Compensation |
$451.00
|
|
|
REMOVAL OF OVARY(S)
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 58940
|
| Hospital Charge Code |
6158940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.00 |
| Max. Negotiated Rate |
$1,022.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$645.60
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cigna Commercial |
$914.60
|
| Rate for Payer: First Health Commercial |
$968.40
|
| Rate for Payer: First Health Workers Compensation |
$415.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$968.40
|
| Rate for Payer: GEHA Commercial |
$860.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$968.40
|
| Rate for Payer: Humana ChoiceCare |
$279.76
|
| Rate for Payer: Multiplan All |
$979.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$645.60
|
| Rate for Payer: OMNI Networks Commercial |
$753.20
|
| Rate for Payer: One Health Plan PPO/POS |
$968.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,022.20
|
| Rate for Payer: Three Rivers Provider Network All |
$807.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$946.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$269.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,000.68
|
| Rate for Payer: Zelis Auto |
$430.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$538.00
|
| Rate for Payer: Zelis Worker's Compensation |
$293.75
|
|
|
REMOVAL OF OVARY(S)
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 58940
|
| Hospital Charge Code |
6158940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$293.75 |
| Max. Negotiated Rate |
$1,022.20 |
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cigna Commercial |
$914.60
|
| Rate for Payer: First Health Commercial |
$968.40
|
| Rate for Payer: First Health Workers Compensation |
$415.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$968.40
|
| Rate for Payer: GEHA Commercial |
$753.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$968.40
|
| Rate for Payer: Multiplan All |
$979.16
|
| Rate for Payer: OMNI Networks Commercial |
$753.20
|
| Rate for Payer: One Health Plan PPO/POS |
$968.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,022.20
|
| Rate for Payer: Three Rivers Provider Network All |
$807.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,000.68
|
| Rate for Payer: Zelis Auto |
$430.40
|
| Rate for Payer: Zelis Worker's Compensation |
$293.75
|
|
|
REMOVAL OF PALM TENDON EACH
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT 26170
|
| Hospital Charge Code |
6126170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.04 |
| Max. Negotiated Rate |
$776.15 |
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$694.45
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: First Health Workers Compensation |
$315.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$735.30
|
| Rate for Payer: GEHA Commercial |
$571.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$735.30
|
| Rate for Payer: Multiplan All |
$743.47
|
| Rate for Payer: OMNI Networks Commercial |
$571.90
|
| Rate for Payer: One Health Plan PPO/POS |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$776.15
|
| Rate for Payer: Three Rivers Provider Network All |
$612.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$759.81
|
| Rate for Payer: Zelis Auto |
$326.80
|
| Rate for Payer: Zelis Worker's Compensation |
$223.04
|
|
|
REMOVAL OF PALM TENDON EACH
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT 26170
|
| Hospital Charge Code |
6126170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.04 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$490.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$694.45
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: First Health Workers Compensation |
$315.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$735.30
|
| Rate for Payer: GEHA Commercial |
$653.60
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$735.30
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$743.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$571.90
|
| Rate for Payer: One Health Plan PPO/POS |
$735.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$776.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$612.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$759.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$326.80
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$223.04
|
|
|
REMOVAL OF PANCREAS
|
Facility
|
OP
|
$3,825.00
|
|
|
Service Code
|
CPT 48155
|
| Hospital Charge Code |
6148155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$956.25 |
| Max. Negotiated Rate |
$3,633.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$3,251.25
|
| Rate for Payer: First Health Commercial |
$3,442.50
|
| Rate for Payer: First Health Workers Compensation |
$1,476.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,442.50
|
| Rate for Payer: GEHA Commercial |
$3,060.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,442.50
|
| Rate for Payer: Humana ChoiceCare |
$994.50
|
| Rate for Payer: Multiplan All |
$3,480.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,295.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,677.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,442.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,633.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,868.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,366.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$956.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,557.25
|
| Rate for Payer: Zelis Auto |
$1,530.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,912.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,044.22
|
|
|
REMOVAL OF PANCREAS
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
CPT 48155
|
| Hospital Charge Code |
6148155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,044.22 |
| Max. Negotiated Rate |
$3,633.75 |
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$3,251.25
|
| Rate for Payer: First Health Commercial |
$3,442.50
|
| Rate for Payer: First Health Workers Compensation |
$1,476.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,442.50
|
| Rate for Payer: GEHA Commercial |
$2,677.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,442.50
|
| Rate for Payer: Multiplan All |
$3,480.75
|
| Rate for Payer: OMNI Networks Commercial |
$2,677.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,442.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,633.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,868.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,557.25
|
| Rate for Payer: Zelis Auto |
$1,530.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,044.22
|
|
|
REMOVAL OF PANCREAS LESION
|
Facility
|
OP
|
$2,331.00
|
|
|
Service Code
|
CPT 48120
|
| Hospital Charge Code |
6148120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.75 |
| Max. Negotiated Rate |
$2,214.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,398.60
|
| Rate for Payer: Cash Price |
$1,398.60
|
| Rate for Payer: Cigna Commercial |
$1,981.35
|
| Rate for Payer: First Health Commercial |
$2,097.90
|
| Rate for Payer: First Health Workers Compensation |
$900.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,097.90
|
| Rate for Payer: GEHA Commercial |
$1,864.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,097.90
|
| Rate for Payer: Humana ChoiceCare |
$606.06
|
| Rate for Payer: Multiplan All |
$2,121.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,398.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,631.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,097.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,214.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,748.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,051.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$582.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,167.83
|
| Rate for Payer: Zelis Auto |
$932.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,165.50
|
| Rate for Payer: Zelis Worker's Compensation |
$636.36
|
|
|
REMOVAL OF PANCREAS LESION
|
Facility
|
IP
|
$2,331.00
|
|
|
Service Code
|
CPT 48120
|
| Hospital Charge Code |
6148120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$636.36 |
| Max. Negotiated Rate |
$2,214.45 |
| Rate for Payer: Cash Price |
$1,398.60
|
| Rate for Payer: Cigna Commercial |
$1,981.35
|
| Rate for Payer: First Health Commercial |
$2,097.90
|
| Rate for Payer: First Health Workers Compensation |
$900.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,097.90
|
| Rate for Payer: GEHA Commercial |
$1,631.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,097.90
|
| Rate for Payer: Multiplan All |
$2,121.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,631.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,097.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,214.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,748.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,167.83
|
| Rate for Payer: Zelis Auto |
$932.40
|
| Rate for Payer: Zelis Worker's Compensation |
$636.36
|
|
