|
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 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 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 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 |
$9,374.72 |
| 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 |
$4,687.36
|
| 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 |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| 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 |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| 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
|
$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
|
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
|
$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 |
$6,158.84 |
| 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 |
$3,079.42
|
| 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 |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
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 |
$6,158.84 |
| 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 |
$3,079.42
|
| 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 |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
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 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 |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$3,274.93
|
| 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 |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$919.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$939.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$404.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$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 |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$3,080.89
|
| 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 |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.98
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,248.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.59
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.15
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$548.88
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$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 |
$5,977.36 |
| 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 |
$2,988.68
|
| 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 |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,910.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| 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 |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,910.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| 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
|
$377.34
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$377.34 |
| 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 |
$188.67
|
| Rate for Payer: First Health Workers Compensation |
$242.82
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| 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 |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$171.69
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 44121
|
| Hospital Charge Code |
6144121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$612.75 |
| 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 |
$451.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$580.50
|
| Rate for Payer: Multiplan All |
$586.95
|
| 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: United Payors & United Providers UP&UP |
$599.85
|
| Rate for Payer: Zelis Auto |
$258.00
|
| Rate for Payer: Zelis Worker's Compensation |
$176.09
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
IP
|
$2,488.00
|
|
|
Service Code
|
CPT 44125
|
| Hospital Charge Code |
6144125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$679.22 |
| Max. Negotiated Rate |
$2,363.60 |
| 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 |
$1,741.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,239.20
|
| Rate for Payer: Multiplan All |
$2,264.08
|
| 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: United Payors & United Providers UP&UP |
$2,313.84
|
| Rate for Payer: Zelis Auto |
$995.20
|
| Rate for Payer: Zelis Worker's Compensation |
$679.22
|
|
|
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
|
|
