|
REMOVAL OF PANCREATIC DUCT
|
Facility
|
OP
|
$2,619.00
|
|
|
Service Code
|
CPT 48148
|
| Hospital Charge Code |
6148148
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$654.75 |
| Max. Negotiated Rate |
$2,488.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,571.40
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cigna Commercial |
$2,226.15
|
| Rate for Payer: First Health Commercial |
$2,357.10
|
| Rate for Payer: First Health Workers Compensation |
$1,011.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,357.10
|
| Rate for Payer: GEHA Commercial |
$2,095.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,357.10
|
| Rate for Payer: Humana ChoiceCare |
$680.94
|
| Rate for Payer: Multiplan All |
$2,383.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,571.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,833.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,357.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,488.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,964.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,304.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$654.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,435.67
|
| Rate for Payer: Zelis Auto |
$1,047.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,309.50
|
| Rate for Payer: Zelis Worker's Compensation |
$714.99
|
|
|
REMOVAL OF PANCREATIC DUCT
|
Facility
|
IP
|
$2,619.00
|
|
|
Service Code
|
CPT 48148
|
| Hospital Charge Code |
6148148
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$714.99 |
| Max. Negotiated Rate |
$2,488.05 |
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cigna Commercial |
$2,226.15
|
| Rate for Payer: First Health Commercial |
$2,357.10
|
| Rate for Payer: First Health Workers Compensation |
$1,011.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,357.10
|
| Rate for Payer: GEHA Commercial |
$1,833.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,357.10
|
| Rate for Payer: Multiplan All |
$2,383.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,833.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,357.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,488.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,964.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,435.67
|
| Rate for Payer: Zelis Auto |
$1,047.60
|
| Rate for Payer: Zelis Worker's Compensation |
$714.99
|
|
|
REMOVAL OF PANCREATIC STONE
|
Facility
|
IP
|
$2,461.00
|
|
|
Service Code
|
CPT 48020
|
| Hospital Charge Code |
6148020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$671.85 |
| Max. Negotiated Rate |
$2,337.95 |
| Rate for Payer: Cash Price |
$1,476.60
|
| Rate for Payer: Cigna Commercial |
$2,091.85
|
| Rate for Payer: First Health Commercial |
$2,214.90
|
| Rate for Payer: First Health Workers Compensation |
$950.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,214.90
|
| Rate for Payer: GEHA Commercial |
$1,722.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,214.90
|
| Rate for Payer: Multiplan All |
$2,239.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,722.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,214.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,337.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,845.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,288.73
|
| Rate for Payer: Zelis Auto |
$984.40
|
| Rate for Payer: Zelis Worker's Compensation |
$671.85
|
|
|
REMOVAL OF PANCREATIC STONE
|
Facility
|
OP
|
$2,461.00
|
|
|
Service Code
|
CPT 48020
|
| Hospital Charge Code |
6148020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$2,337.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,476.60
|
| Rate for Payer: Cash Price |
$1,476.60
|
| Rate for Payer: Cigna Commercial |
$2,091.85
|
| Rate for Payer: First Health Commercial |
$2,214.90
|
| Rate for Payer: First Health Workers Compensation |
$950.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,214.90
|
| Rate for Payer: GEHA Commercial |
$1,968.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,214.90
|
| Rate for Payer: Humana ChoiceCare |
$639.86
|
| Rate for Payer: Multiplan All |
$2,239.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,476.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,722.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,214.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,337.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,845.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,165.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$615.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,288.73
|
| Rate for Payer: Zelis Auto |
$984.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,230.50
|
| Rate for Payer: Zelis Worker's Compensation |
$671.85
|
|
|
REMOVAL OF PELVIC STRUCTURES
|
Facility
|
IP
|
$4,759.00
|
|
|
Service Code
|
CPT 51597
|
| Hospital Charge Code |
6151597
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,299.21 |
| Max. Negotiated Rate |
$4,521.05 |
| Rate for Payer: Cash Price |
$2,855.40
|
| Rate for Payer: Cigna Commercial |
$4,045.15
|
| Rate for Payer: First Health Commercial |
$4,283.10
|
| Rate for Payer: First Health Workers Compensation |
$1,837.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,283.10
|
| Rate for Payer: GEHA Commercial |
$3,331.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,283.10
|
| Rate for Payer: Multiplan All |
$4,330.69
|
| Rate for Payer: OMNI Networks Commercial |
$3,331.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,283.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,521.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,569.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,425.87
|
| Rate for Payer: Zelis Auto |
$1,903.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,299.21
|
|
|
REMOVAL OF PELVIC STRUCTURES
|
Facility
|
OP
|
$4,759.00
|
|
|
Service Code
|
CPT 51597
|
| Hospital Charge Code |
6151597
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,189.75 |
| Max. Negotiated Rate |
$4,521.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,855.40
|
| Rate for Payer: Cash Price |
$2,855.40
|
| Rate for Payer: Cigna Commercial |
$4,045.15
|
| Rate for Payer: First Health Commercial |
$4,283.10
|
| Rate for Payer: First Health Workers Compensation |
$1,837.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,283.10
|
| Rate for Payer: GEHA Commercial |
$3,807.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,283.10
|
| Rate for Payer: Humana ChoiceCare |
$1,237.34
|
| Rate for Payer: Multiplan All |
$4,330.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,855.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,331.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,283.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,521.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,569.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,187.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,189.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,425.87
|
| Rate for Payer: Zelis Auto |
$1,903.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,379.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,299.21
|
|
|
REMOVAL OF PENIS
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 54125
|
| Hospital Charge Code |
6154125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.75 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: First Health Workers Compensation |
$646.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Humana ChoiceCare |
$435.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,474.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$837.50
|
| Rate for Payer: Zelis Worker's Compensation |
$457.27
|
|
|
REMOVAL OF PENIS
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 54125
|
| Hospital Charge Code |
6154125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$457.27 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: First Health Workers Compensation |
$646.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
| Rate for Payer: Zelis Worker's Compensation |
$457.27
|
|
|
REMOVAL OF PILONIDAL LESION
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
6111772
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$823.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
REMOVAL OF PILONIDAL LESION
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
6111771
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$625.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: Zelis Auto |
$357.20
|
| Rate for Payer: Zelis Worker's Compensation |
$243.79
|
|
|
REMOVAL OF PILONIDAL LESION
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
6111771
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$714.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$357.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$243.79
|
|
|
REMOVAL OF PILONIDAL LESION
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
6111772
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$706.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$941.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
REMOVAL OF PROSTATE
|
Facility
|
OP
|
$2,273.00
|
|
|
Service Code
|
CPT 55801
|
| Hospital Charge Code |
6155801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$568.25 |
| Max. Negotiated Rate |
$2,159.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,363.80
|
| Rate for Payer: Cash Price |
$1,363.80
|
| Rate for Payer: Cigna Commercial |
$1,932.05
|
| Rate for Payer: First Health Commercial |
$2,045.70
|
| Rate for Payer: First Health Workers Compensation |
$877.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,045.70
|
| Rate for Payer: GEHA Commercial |
$1,818.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,045.70
|
| Rate for Payer: Humana ChoiceCare |
$590.98
|
| Rate for Payer: Multiplan All |
$2,068.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,363.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,591.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,045.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,159.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,704.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,000.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$568.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,113.89
|
| Rate for Payer: Zelis Auto |
$909.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,136.50
|
| Rate for Payer: Zelis Worker's Compensation |
$620.53
|
|
|
REMOVAL OF PROSTATE
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
CPT 55821
|
| Hospital Charge Code |
6155821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.75 |
| Max. Negotiated Rate |
$1,712.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cigna Commercial |
$1,532.55
|
| Rate for Payer: First Health Commercial |
$1,622.70
|
| Rate for Payer: First Health Workers Compensation |
$696.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,622.70
|
| Rate for Payer: GEHA Commercial |
$1,442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,622.70
|
| Rate for Payer: Humana ChoiceCare |
$468.78
|
| Rate for Payer: Multiplan All |
$1,640.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,081.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,262.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,622.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,712.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,352.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,586.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$450.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,676.79
|
| Rate for Payer: Zelis Auto |
$721.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$901.50
|
| Rate for Payer: Zelis Worker's Compensation |
$492.22
|
|
|
REMOVAL OF PROSTATE
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
CPT 55821
|
| Hospital Charge Code |
6155821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$492.22 |
| Max. Negotiated Rate |
$1,712.85 |
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cigna Commercial |
$1,532.55
|
| Rate for Payer: First Health Commercial |
$1,622.70
|
| Rate for Payer: First Health Workers Compensation |
$696.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,622.70
|
| Rate for Payer: GEHA Commercial |
$1,262.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,622.70
|
| Rate for Payer: Multiplan All |
$1,640.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,262.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,622.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,712.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,352.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,676.79
|
| Rate for Payer: Zelis Auto |
$721.20
|
| Rate for Payer: Zelis Worker's Compensation |
$492.22
|
|
|
REMOVAL OF PROSTATE
|
Facility
|
IP
|
$2,273.00
|
|
|
Service Code
|
CPT 55801
|
| Hospital Charge Code |
6155801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$620.53 |
| Max. Negotiated Rate |
$2,159.35 |
| Rate for Payer: Cash Price |
$1,363.80
|
| Rate for Payer: Cigna Commercial |
$1,932.05
|
| Rate for Payer: First Health Commercial |
$2,045.70
|
| Rate for Payer: First Health Workers Compensation |
$877.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,045.70
|
| Rate for Payer: GEHA Commercial |
$1,591.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,045.70
|
| Rate for Payer: Multiplan All |
$2,068.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,591.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,045.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,159.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,704.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,113.89
|
| Rate for Payer: Zelis Auto |
$909.20
|
| Rate for Payer: Zelis Worker's Compensation |
$620.53
|
|
|
REMOVAL OF PROSTATE
|
Facility
|
IP
|
$1,951.00
|
|
|
Service Code
|
CPT 55831
|
| Hospital Charge Code |
6155831
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$532.62 |
| Max. Negotiated Rate |
$1,853.45 |
| Rate for Payer: Cash Price |
$1,170.60
|
| Rate for Payer: Cigna Commercial |
$1,658.35
|
| Rate for Payer: First Health Commercial |
$1,755.90
|
| Rate for Payer: First Health Workers Compensation |
$753.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,755.90
|
| Rate for Payer: GEHA Commercial |
$1,365.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,755.90
|
| Rate for Payer: Multiplan All |
$1,775.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,365.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,755.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,853.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,463.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,814.43
|
| Rate for Payer: Zelis Auto |
$780.40
|
| Rate for Payer: Zelis Worker's Compensation |
$532.62
|
|
|
REMOVAL OF PROSTATE
|
Facility
|
OP
|
$1,951.00
|
|
|
Service Code
|
CPT 55831
|
| Hospital Charge Code |
6155831
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.75 |
| Max. Negotiated Rate |
$1,853.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,170.60
|
| Rate for Payer: Cash Price |
$1,170.60
|
| Rate for Payer: Cigna Commercial |
$1,658.35
|
| Rate for Payer: First Health Commercial |
$1,755.90
|
| Rate for Payer: First Health Workers Compensation |
$753.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,755.90
|
| Rate for Payer: GEHA Commercial |
$1,560.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,755.90
|
| Rate for Payer: Humana ChoiceCare |
$507.26
|
| Rate for Payer: Multiplan All |
$1,775.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,170.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,365.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,755.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,853.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,463.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,716.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,814.43
|
| Rate for Payer: Zelis Auto |
$780.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$975.50
|
| Rate for Payer: Zelis Worker's Compensation |
$532.62
|
|
|
REMOVAL OF RECTAL MARKER
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 46030
|
| Hospital Charge Code |
6146030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
REMOVAL OF RECTAL MARKER
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 46030
|
| Hospital Charge Code |
6146030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$429.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$222.40
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$438.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$506.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$438.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$438.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
REMOVAL OF RECTUM
|
Facility
|
OP
|
$3,131.00
|
|
|
Service Code
|
CPT 45120
|
| Hospital Charge Code |
6145120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$2,974.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,878.60
|
| Rate for Payer: Cash Price |
$1,878.60
|
| Rate for Payer: Cigna Commercial |
$2,661.35
|
| Rate for Payer: First Health Commercial |
$2,817.90
|
| Rate for Payer: First Health Workers Compensation |
$1,208.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,817.90
|
| Rate for Payer: GEHA Commercial |
$2,504.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,817.90
|
| Rate for Payer: Humana ChoiceCare |
$814.06
|
| Rate for Payer: Multiplan All |
$2,849.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,878.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,191.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,817.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,974.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,348.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,755.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$782.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,911.83
|
| Rate for Payer: Zelis Auto |
$1,252.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,565.50
|
| Rate for Payer: Zelis Worker's Compensation |
$854.76
|
|
|
REMOVAL OF RECTUM
|
Facility
|
IP
|
$3,131.00
|
|
|
Service Code
|
CPT 45120
|
| Hospital Charge Code |
6145120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$854.76 |
| Max. Negotiated Rate |
$2,974.45 |
| Rate for Payer: Cash Price |
$1,878.60
|
| Rate for Payer: Cigna Commercial |
$2,661.35
|
| Rate for Payer: First Health Commercial |
$2,817.90
|
| Rate for Payer: First Health Workers Compensation |
$1,208.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,817.90
|
| Rate for Payer: GEHA Commercial |
$2,191.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,817.90
|
| Rate for Payer: Multiplan All |
$2,849.21
|
| Rate for Payer: OMNI Networks Commercial |
$2,191.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,817.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,974.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,348.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,911.83
|
| Rate for Payer: Zelis Auto |
$1,252.40
|
| Rate for Payer: Zelis Worker's Compensation |
$854.76
|
|
|
REMOVAL OF RECTUM
|
Facility
|
IP
|
$3,866.00
|
|
|
Service Code
|
CPT 45110
|
| Hospital Charge Code |
6145110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,055.42 |
| Max. Negotiated Rate |
$3,672.70 |
| Rate for Payer: Cash Price |
$2,319.60
|
| Rate for Payer: Cigna Commercial |
$3,286.10
|
| Rate for Payer: First Health Commercial |
$3,479.40
|
| Rate for Payer: First Health Workers Compensation |
$1,492.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,479.40
|
| Rate for Payer: GEHA Commercial |
$2,706.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,479.40
|
| Rate for Payer: Multiplan All |
$3,518.06
|
| Rate for Payer: OMNI Networks Commercial |
$2,706.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,479.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,672.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,899.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,595.38
|
| Rate for Payer: Zelis Auto |
$1,546.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,055.42
|
|
|
REMOVAL OF RECTUM
|
Facility
|
OP
|
$3,866.00
|
|
|
Service Code
|
CPT 45110
|
| Hospital Charge Code |
6145110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$966.50 |
| Max. Negotiated Rate |
$3,672.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,319.60
|
| Rate for Payer: Cash Price |
$2,319.60
|
| Rate for Payer: Cigna Commercial |
$3,286.10
|
| Rate for Payer: First Health Commercial |
$3,479.40
|
| Rate for Payer: First Health Workers Compensation |
$1,492.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,479.40
|
| Rate for Payer: GEHA Commercial |
$3,092.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,479.40
|
| Rate for Payer: Humana ChoiceCare |
$1,005.16
|
| Rate for Payer: Multiplan All |
$3,518.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,319.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,706.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,479.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,672.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,899.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,402.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$966.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,595.38
|
| Rate for Payer: Zelis Auto |
$1,546.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,933.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,055.42
|
|
|
REMOVAL OF RECTUM
|
Facility
|
IP
|
$3,941.00
|
|
|
Service Code
|
CPT 45112
|
| Hospital Charge Code |
6145112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,075.89 |
| Max. Negotiated Rate |
$3,743.95 |
| Rate for Payer: Cash Price |
$2,364.60
|
| Rate for Payer: Cigna Commercial |
$3,349.85
|
| Rate for Payer: First Health Commercial |
$3,546.90
|
| Rate for Payer: First Health Workers Compensation |
$1,521.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,546.90
|
| Rate for Payer: GEHA Commercial |
$2,758.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,546.90
|
| Rate for Payer: Multiplan All |
$3,586.31
|
| Rate for Payer: OMNI Networks Commercial |
$2,758.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,546.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,743.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,955.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,665.13
|
| Rate for Payer: Zelis Auto |
$1,576.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,075.89
|
|
