|
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 AND COLON
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
CPT 45121
|
| Hospital Charge Code |
6145121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$914.50 |
| Max. Negotiated Rate |
$3,475.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$3,109.30
|
| Rate for Payer: First Health Commercial |
$3,292.20
|
| Rate for Payer: First Health Workers Compensation |
$1,412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,292.20
|
| Rate for Payer: GEHA Commercial |
$2,926.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,292.20
|
| Rate for Payer: Humana ChoiceCare |
$951.08
|
| Rate for Payer: Multiplan All |
$3,328.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,194.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,560.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,292.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,475.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,743.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,219.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$914.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,401.94
|
| Rate for Payer: Zelis Auto |
$1,463.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,829.00
|
| Rate for Payer: Zelis Worker's Compensation |
$998.63
|
|
|
REMOVAL OF RECTUM AND COLON
|
Facility
|
IP
|
$3,658.00
|
|
|
Service Code
|
CPT 45121
|
| Hospital Charge Code |
6145121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$998.63 |
| Max. Negotiated Rate |
$3,475.10 |
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$3,109.30
|
| Rate for Payer: First Health Commercial |
$3,292.20
|
| Rate for Payer: First Health Workers Compensation |
$1,412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,292.20
|
| Rate for Payer: GEHA Commercial |
$2,560.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,292.20
|
| Rate for Payer: Multiplan All |
$3,328.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,560.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,292.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,475.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,743.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,401.94
|
| Rate for Payer: Zelis Auto |
$1,463.20
|
| Rate for Payer: Zelis Worker's Compensation |
$998.63
|
|
|
REMOVAL OF RESIDUAL CERVIX
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 57550
|
| Hospital Charge Code |
6157550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$779.00 |
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$574.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
|
REMOVAL OF RESIDUAL CERVIX
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 57550
|
| Hospital Charge Code |
6157550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$9,566.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,783.32
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$656.00
|
| Rate for Payer: GEHA Medicare |
$4,783.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Humana ChoiceCare |
$5,261.65
|
| Rate for Payer: Humana Medicare Advantage |
$4,783.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,035.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,783.32
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,131.64
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,783.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,566.64
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,687.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,783.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,783.32
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Medicare |
$4,065.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,739.98
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
|
REMOVAL OF RESIDUAL CERVIX
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 57540
|
| Hospital Charge Code |
6157540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.25 |
| Max. Negotiated Rate |
$1,513.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cigna Commercial |
$1,354.05
|
| Rate for Payer: First Health Commercial |
$1,433.70
|
| Rate for Payer: First Health Workers Compensation |
$615.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,433.70
|
| Rate for Payer: GEHA Commercial |
$1,274.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,433.70
|
| Rate for Payer: Humana ChoiceCare |
$414.18
|
| Rate for Payer: Multiplan All |
$1,449.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$955.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,115.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,433.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,513.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,194.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,401.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,481.49
|
| Rate for Payer: Zelis Auto |
$637.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$796.50
|
| Rate for Payer: Zelis Worker's Compensation |
$434.89
|
|
|
REMOVAL OF RESIDUAL CERVIX
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 57540
|
| Hospital Charge Code |
6157540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$434.89 |
| Max. Negotiated Rate |
$1,513.35 |
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cigna Commercial |
$1,354.05
|
| Rate for Payer: First Health Commercial |
$1,433.70
|
| Rate for Payer: First Health Workers Compensation |
$615.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,433.70
|
| Rate for Payer: GEHA Commercial |
$1,115.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,433.70
|
| Rate for Payer: Multiplan All |
$1,449.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,115.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,433.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,513.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,194.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,481.49
|
| Rate for Payer: Zelis Auto |
$637.20
|
| Rate for Payer: Zelis Worker's Compensation |
$434.89
|
|
|
REMOVAL OF RIB
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
CPT 21615
|
| Hospital Charge Code |
6121615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.45 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$1,106.70
|
| Rate for Payer: First Health Commercial |
$1,171.80
|
| Rate for Payer: First Health Workers Compensation |
$502.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,171.80
|
| Rate for Payer: GEHA Commercial |
$911.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,171.80
|
| Rate for Payer: Multiplan All |
$1,184.82
|
| Rate for Payer: OMNI Networks Commercial |
$911.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,171.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,236.90
|
| Rate for Payer: Three Rivers Provider Network All |
$976.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,210.86
|
| Rate for Payer: Zelis Auto |
$520.80
|
| Rate for Payer: Zelis Worker's Compensation |
$355.45
|
|
|
REMOVAL OF RIB
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
CPT 21615
|
| Hospital Charge Code |
6121615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$1,106.70
|
| Rate for Payer: First Health Commercial |
$1,171.80
|
| Rate for Payer: First Health Workers Compensation |
$502.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,171.80
|
| Rate for Payer: GEHA Commercial |
$1,041.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,171.80
|
| Rate for Payer: Humana ChoiceCare |
$338.52
|
| Rate for Payer: Multiplan All |
$1,184.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$781.20
|
| Rate for Payer: OMNI Networks Commercial |
$911.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,171.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,236.90
|
| Rate for Payer: Three Rivers Provider Network All |
$976.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,145.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$325.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,210.86
|
| Rate for Payer: Zelis Auto |
$520.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$651.00
|
| Rate for Payer: Zelis Worker's Compensation |
$355.45
|
|
|
REMOVAL OF RIB AND NERVES
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 21616
|
| Hospital Charge Code |
6121616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.98 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,102.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| Rate for Payer: Multiplan All |
$1,433.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,464.75
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
REMOVAL OF RIB AND NERVES
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
CPT 21616
|
| Hospital Charge Code |
6121616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| Rate for Payer: Humana ChoiceCare |
$409.50
|
| Rate for Payer: Multiplan All |
$1,433.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$945.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,386.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,464.75
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$787.50
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
6142330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$359.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
6142330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.05 |
| 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 |
$307.80
|
| 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 |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$410.40
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| 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 |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| 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 |
$487.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| 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 |
$477.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$205.20
|
| 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 |
$140.05
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 42335
|
| Hospital Charge Code |
6142335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$466.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 42335
|
| Hospital Charge Code |
6142335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| 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 |
$400.20
|
| 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 |
$3,142.47
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$533.60
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| 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 |
$606.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| 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 |
$620.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$266.80
|
| 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 |
$182.09
|
|
|
REMOVAL OF SCROTUM
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT 55150
|
| Hospital Charge Code |
6155150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.73 |
| Max. Negotiated Rate |
$6,683.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$606.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,341.98
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$858.50
|
| Rate for Payer: First Health Commercial |
$909.00
|
| Rate for Payer: First Health Workers Compensation |
$389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.00
|
| Rate for Payer: GEHA Commercial |
$808.00
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$919.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$707.00
|
| Rate for Payer: One Health Plan PPO/POS |
$909.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$939.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$404.00
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$275.73
|
|
|
REMOVAL OF SCROTUM
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT 55150
|
| Hospital Charge Code |
6155150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.73 |
| Max. Negotiated Rate |
$959.50 |
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$858.50
|
| Rate for Payer: First Health Commercial |
$909.00
|
| Rate for Payer: First Health Workers Compensation |
$389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.00
|
| Rate for Payer: GEHA Commercial |
$707.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| Rate for Payer: Multiplan All |
$919.10
|
| Rate for Payer: OMNI Networks Commercial |
$707.00
|
| Rate for Payer: One Health Plan PPO/POS |
$909.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$939.30
|
| Rate for Payer: Zelis Auto |
$404.00
|
| Rate for Payer: Zelis Worker's Compensation |
$275.73
|
|
|
REMOVAL OF SESAMOID BONE
|
Facility
|
OP
|
$1,372.20
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
6128315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.61 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$823.32
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$823.32
|
| Rate for Payer: Cash Price |
$823.32
|
| Rate for Payer: Cigna Commercial |
$1,166.37
|
| Rate for Payer: First Health Commercial |
$1,234.98
|
| Rate for Payer: First Health Workers Compensation |
$529.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.98
|
| Rate for Payer: GEHA Commercial |
$1,097.76
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.98
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,248.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$960.54
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.98
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.59
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.15
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$548.88
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$374.61
|
|
|
REMOVAL OF SESAMOID BONE
|
Facility
|
IP
|
$1,372.20
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
6128315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.61 |
| Max. Negotiated Rate |
$1,303.59 |
| Rate for Payer: Cash Price |
$823.32
|
| Rate for Payer: Cigna Commercial |
$1,166.37
|
| Rate for Payer: First Health Commercial |
$1,234.98
|
| Rate for Payer: First Health Workers Compensation |
$529.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.98
|
| Rate for Payer: GEHA Commercial |
$960.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.98
|
| Rate for Payer: Multiplan All |
$1,248.70
|
| Rate for Payer: OMNI Networks Commercial |
$960.54
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.59
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.15
|
| Rate for Payer: Zelis Auto |
$548.88
|
| Rate for Payer: Zelis Worker's Compensation |
$374.61
|
|
|
REMOVAL OF SHUNT
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 49429
|
| Hospital Charge Code |
6149429
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
REMOVAL OF SHUNT
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 49429
|
| Hospital Charge Code |
6149429
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$6,099.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,363.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$578.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,363.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,872.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,049.86
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: GEHA Medicare |
$3,049.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Humana ChoiceCare |
$3,354.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,049.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,123.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,910.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,049.86
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,184.76
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,205.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,910.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,049.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,099.72
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,988.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,910.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,049.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,049.86
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Medicare |
$2,592.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,659.83
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$385.08
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: First Health Workers Compensation |
$247.80
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$175.21
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
OP
|
$2,579.00
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
6144120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$644.75 |
| Max. Negotiated Rate |
$2,450.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,547.40
|
| Rate for Payer: Cash Price |
$1,547.40
|
| Rate for Payer: Cigna Commercial |
$2,192.15
|
| Rate for Payer: First Health Commercial |
$2,321.10
|
| Rate for Payer: First Health Workers Compensation |
$995.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,321.10
|
| Rate for Payer: GEHA Commercial |
$2,063.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,321.10
|
| Rate for Payer: Humana ChoiceCare |
$670.54
|
| Rate for Payer: Multiplan All |
$2,346.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,547.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,805.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,321.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,450.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,934.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,269.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$644.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,398.47
|
| Rate for Payer: Zelis Auto |
$1,031.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,289.50
|
| Rate for Payer: Zelis Worker's Compensation |
$704.07
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
OP
|
$2,488.00
|
|
|
Service Code
|
CPT 44125
|
| Hospital Charge Code |
6144125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$622.00 |
| Max. Negotiated Rate |
$2,363.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,492.80
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cigna Commercial |
$2,114.80
|
| Rate for Payer: First Health Commercial |
$2,239.20
|
| Rate for Payer: First Health Workers Compensation |
$960.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,239.20
|
| Rate for Payer: GEHA Commercial |
$1,990.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,239.20
|
| Rate for Payer: Humana ChoiceCare |
$646.88
|
| Rate for Payer: Multiplan All |
$2,264.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,492.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,741.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,239.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,363.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,866.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,189.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,313.84
|
| Rate for Payer: Zelis Auto |
$995.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,244.00
|
| Rate for Payer: Zelis Worker's Compensation |
$679.22
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 44121
|
| Hospital Charge Code |
6144121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.25 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: First Health Commercial |
$580.50
|
| Rate for Payer: First Health Workers Compensation |
$249.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$580.50
|
| Rate for Payer: GEHA Commercial |
$516.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$580.50
|
| Rate for Payer: Humana ChoiceCare |
$167.70
|
| Rate for Payer: Multiplan All |
$586.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.00
|
| Rate for Payer: OMNI Networks Commercial |
$451.50
|
| Rate for Payer: One Health Plan PPO/POS |
$580.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$612.75
|
| Rate for Payer: Three Rivers Provider Network All |
$483.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$567.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$161.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$599.85
|
| Rate for Payer: Zelis Auto |
$258.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$322.50
|
| Rate for Payer: Zelis Worker's Compensation |
$176.09
|
|
