|
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
|
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
|
|
|
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 SPERM CORD LESION
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
6155520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.62 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: First Health Workers Compensation |
$362.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$658.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| Rate for Payer: Multiplan All |
$855.40
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.00
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$874.20
|
| Rate for Payer: Zelis Auto |
$376.00
|
| Rate for Payer: Zelis Worker's Compensation |
$256.62
|
|
|
REMOVAL OF SPERM CORD LESION
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
6155520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.62 |
| 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 |
$564.00
|
| 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 |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: First Health Workers Compensation |
$362.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$752.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| 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 |
$855.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| 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 |
$893.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| 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 |
$874.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$376.00
|
| 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 |
$256.62
|
|
|
REMOVAL OF STOMACH
|
Facility
|
IP
|
$4,804.00
|
|
|
Service Code
|
CPT 43621
|
| Hospital Charge Code |
6143621
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,311.49 |
| Max. Negotiated Rate |
$4,563.80 |
| Rate for Payer: Cash Price |
$2,882.40
|
| Rate for Payer: Cigna Commercial |
$4,083.40
|
| Rate for Payer: First Health Commercial |
$4,323.60
|
| Rate for Payer: First Health Workers Compensation |
$1,854.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,323.60
|
| Rate for Payer: GEHA Commercial |
$3,362.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,323.60
|
| Rate for Payer: Multiplan All |
$4,371.64
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,323.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,563.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,603.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,467.72
|
| Rate for Payer: Zelis Auto |
$1,921.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,311.49
|
|
|
REMOVAL OF STOMACH
|
Facility
|
IP
|
$4,132.00
|
|
|
Service Code
|
CPT 43620
|
| Hospital Charge Code |
6143620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,128.04 |
| Max. Negotiated Rate |
$3,925.40 |
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cigna Commercial |
$3,512.20
|
| Rate for Payer: First Health Commercial |
$3,718.80
|
| Rate for Payer: First Health Workers Compensation |
$1,595.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,718.80
|
| Rate for Payer: GEHA Commercial |
$2,892.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,718.80
|
| Rate for Payer: Multiplan All |
$3,760.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,892.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,718.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,925.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,099.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,842.76
|
| Rate for Payer: Zelis Auto |
$1,652.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,128.04
|
|
|
REMOVAL OF STOMACH
|
Facility
|
IP
|
$4,902.00
|
|
|
Service Code
|
CPT 43622
|
| Hospital Charge Code |
6143622
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,338.25 |
| Max. Negotiated Rate |
$4,656.90 |
| Rate for Payer: Cash Price |
$2,941.20
|
| Rate for Payer: Cigna Commercial |
$4,166.70
|
| Rate for Payer: First Health Commercial |
$4,411.80
|
| Rate for Payer: First Health Workers Compensation |
$1,892.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,411.80
|
| Rate for Payer: GEHA Commercial |
$3,431.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,411.80
|
| Rate for Payer: Multiplan All |
$4,460.82
|
| Rate for Payer: OMNI Networks Commercial |
$3,431.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,411.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,656.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,676.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,558.86
|
| Rate for Payer: Zelis Auto |
$1,960.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,338.25
|
|
|
REMOVAL OF STOMACH
|
Facility
|
OP
|
$4,132.00
|
|
|
Service Code
|
CPT 43620
|
| Hospital Charge Code |
6143620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,033.00 |
| Max. Negotiated Rate |
$3,925.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cigna Commercial |
$3,512.20
|
| Rate for Payer: First Health Commercial |
$3,718.80
|
| Rate for Payer: First Health Workers Compensation |
$1,595.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,718.80
|
| Rate for Payer: GEHA Commercial |
$3,305.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,718.80
|
| Rate for Payer: Humana ChoiceCare |
$1,074.32
|
| Rate for Payer: Multiplan All |
$3,760.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,479.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,892.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,718.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,925.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,099.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,636.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,033.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,842.76
|
| Rate for Payer: Zelis Auto |
$1,652.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,066.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,128.04
|
|
|
REMOVAL OF STOMACH
|
Facility
|
OP
|
$4,902.00
|
|
|
Service Code
|
CPT 43622
|
| Hospital Charge Code |
6143622
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,225.50 |
| Max. Negotiated Rate |
$4,656.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,941.20
|
| Rate for Payer: Cash Price |
$2,941.20
|
| Rate for Payer: Cigna Commercial |
$4,166.70
|
| Rate for Payer: First Health Commercial |
$4,411.80
|
| Rate for Payer: First Health Workers Compensation |
$1,892.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,411.80
|
| Rate for Payer: GEHA Commercial |
$3,921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,411.80
|
| Rate for Payer: Humana ChoiceCare |
$1,274.52
|
| Rate for Payer: Multiplan All |
$4,460.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,941.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,431.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,411.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,656.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,676.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,313.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,225.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,558.86
|
| Rate for Payer: Zelis Auto |
$1,960.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,451.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,338.25
|
|
|
REMOVAL OF STOMACH
|
Facility
|
OP
|
$4,804.00
|
|
|
Service Code
|
CPT 43621
|
| Hospital Charge Code |
6143621
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,201.00 |
| Max. Negotiated Rate |
$4,563.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,882.40
|
| Rate for Payer: Cash Price |
$2,882.40
|
| Rate for Payer: Cigna Commercial |
$4,083.40
|
| Rate for Payer: First Health Commercial |
$4,323.60
|
| Rate for Payer: First Health Workers Compensation |
$1,854.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,323.60
|
| Rate for Payer: GEHA Commercial |
$3,843.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,323.60
|
| Rate for Payer: Humana ChoiceCare |
$1,249.04
|
| Rate for Payer: Multiplan All |
$4,371.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,882.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,323.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,563.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,603.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,227.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,467.72
|
| Rate for Payer: Zelis Auto |
$1,921.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,402.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,311.49
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
IP
|
$4,471.00
|
|
|
Service Code
|
CPT 43634
|
| Hospital Charge Code |
6143634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,220.58 |
| Max. Negotiated Rate |
$4,247.45 |
| Rate for Payer: Cash Price |
$2,682.60
|
| Rate for Payer: Cigna Commercial |
$3,800.35
|
| Rate for Payer: First Health Commercial |
$4,023.90
|
| Rate for Payer: First Health Workers Compensation |
$1,726.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,023.90
|
| Rate for Payer: GEHA Commercial |
$3,129.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,023.90
|
| Rate for Payer: Multiplan All |
$4,068.61
|
| Rate for Payer: OMNI Networks Commercial |
$3,129.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,023.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,247.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,158.03
|
| Rate for Payer: Zelis Auto |
$1,788.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,220.58
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
IP
|
$4,057.00
|
|
|
Service Code
|
CPT 43633
|
| Hospital Charge Code |
6143633
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,107.56 |
| Max. Negotiated Rate |
$3,854.15 |
| Rate for Payer: Cash Price |
$2,434.20
|
| Rate for Payer: Cigna Commercial |
$3,448.45
|
| Rate for Payer: First Health Commercial |
$3,651.30
|
| Rate for Payer: First Health Workers Compensation |
$1,566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,651.30
|
| Rate for Payer: GEHA Commercial |
$2,839.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,651.30
|
| Rate for Payer: Multiplan All |
$3,691.87
|
| Rate for Payer: OMNI Networks Commercial |
$2,839.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,651.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,854.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,042.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,773.01
|
| Rate for Payer: Zelis Auto |
$1,622.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,107.56
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
OP
|
$4,471.00
|
|
|
Service Code
|
CPT 43634
|
| Hospital Charge Code |
6143634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,117.75 |
| Max. Negotiated Rate |
$4,247.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,682.60
|
| Rate for Payer: Cash Price |
$2,682.60
|
| Rate for Payer: Cigna Commercial |
$3,800.35
|
| Rate for Payer: First Health Commercial |
$4,023.90
|
| Rate for Payer: First Health Workers Compensation |
$1,726.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,023.90
|
| Rate for Payer: GEHA Commercial |
$3,576.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,023.90
|
| Rate for Payer: Humana ChoiceCare |
$1,162.46
|
| Rate for Payer: Multiplan All |
$4,068.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,682.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,129.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,023.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,247.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,353.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,934.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,158.03
|
| Rate for Payer: Zelis Auto |
$1,788.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,235.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,220.58
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
IP
|
$4,295.00
|
|
|
Service Code
|
CPT 43632
|
| Hospital Charge Code |
6143632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,172.54 |
| Max. Negotiated Rate |
$4,080.25 |
| Rate for Payer: Cash Price |
$2,577.00
|
| Rate for Payer: Cigna Commercial |
$3,650.75
|
| Rate for Payer: First Health Commercial |
$3,865.50
|
| Rate for Payer: First Health Workers Compensation |
$1,658.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,865.50
|
| Rate for Payer: GEHA Commercial |
$3,006.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,865.50
|
| Rate for Payer: Multiplan All |
$3,908.45
|
| Rate for Payer: OMNI Networks Commercial |
$3,006.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,865.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,080.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,994.35
|
| Rate for Payer: Zelis Auto |
$1,718.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,172.54
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 43635
|
| Hospital Charge Code |
6143635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.01 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cigna Commercial |
$305.15
|
| Rate for Payer: First Health Commercial |
$323.10
|
| Rate for Payer: First Health Workers Compensation |
$138.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$323.10
|
| Rate for Payer: GEHA Commercial |
$251.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$323.10
|
| Rate for Payer: Multiplan All |
$326.69
|
| Rate for Payer: OMNI Networks Commercial |
$251.30
|
| Rate for Payer: One Health Plan PPO/POS |
$323.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$341.05
|
| Rate for Payer: Three Rivers Provider Network All |
$269.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$333.87
|
| Rate for Payer: Zelis Auto |
$143.60
|
| Rate for Payer: Zelis Worker's Compensation |
$98.01
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
OP
|
$3,056.00
|
|
|
Service Code
|
CPT 43631
|
| Hospital Charge Code |
6143631
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$764.00 |
| Max. Negotiated Rate |
$2,903.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,833.60
|
| Rate for Payer: Cash Price |
$1,833.60
|
| Rate for Payer: Cigna Commercial |
$2,597.60
|
| Rate for Payer: First Health Commercial |
$2,750.40
|
| Rate for Payer: First Health Workers Compensation |
$1,179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,750.40
|
| Rate for Payer: GEHA Commercial |
$2,444.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,750.40
|
| Rate for Payer: Humana ChoiceCare |
$794.56
|
| Rate for Payer: Multiplan All |
$2,780.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,833.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,139.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,750.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,903.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,292.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,689.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$764.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,842.08
|
| Rate for Payer: Zelis Auto |
$1,222.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$834.29
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
OP
|
$4,057.00
|
|
|
Service Code
|
CPT 43633
|
| Hospital Charge Code |
6143633
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,014.25 |
| Max. Negotiated Rate |
$3,854.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,434.20
|
| Rate for Payer: Cash Price |
$2,434.20
|
| Rate for Payer: Cigna Commercial |
$3,448.45
|
| Rate for Payer: First Health Commercial |
$3,651.30
|
| Rate for Payer: First Health Workers Compensation |
$1,566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,651.30
|
| Rate for Payer: GEHA Commercial |
$3,245.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,651.30
|
| Rate for Payer: Humana ChoiceCare |
$1,054.82
|
| Rate for Payer: Multiplan All |
$3,691.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,434.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,839.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,651.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,854.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,042.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,570.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,014.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,773.01
|
| Rate for Payer: Zelis Auto |
$1,622.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,028.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,107.56
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
OP
|
$4,295.00
|
|
|
Service Code
|
CPT 43632
|
| Hospital Charge Code |
6143632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,073.75 |
| Max. Negotiated Rate |
$4,080.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,577.00
|
| Rate for Payer: Cash Price |
$2,577.00
|
| Rate for Payer: Cigna Commercial |
$3,650.75
|
| Rate for Payer: First Health Commercial |
$3,865.50
|
| Rate for Payer: First Health Workers Compensation |
$1,658.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,865.50
|
| Rate for Payer: GEHA Commercial |
$3,436.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,865.50
|
| Rate for Payer: Humana ChoiceCare |
$1,116.70
|
| Rate for Payer: Multiplan All |
$3,908.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,577.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,006.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,865.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,080.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,221.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,779.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,073.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,994.35
|
| Rate for Payer: Zelis Auto |
$1,718.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,147.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,172.54
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 43635
|
| Hospital Charge Code |
6143635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.75 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cigna Commercial |
$305.15
|
| Rate for Payer: First Health Commercial |
$323.10
|
| Rate for Payer: First Health Workers Compensation |
$138.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$323.10
|
| Rate for Payer: GEHA Commercial |
$287.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$323.10
|
| Rate for Payer: Humana ChoiceCare |
$93.34
|
| Rate for Payer: Multiplan All |
$326.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$215.40
|
| Rate for Payer: OMNI Networks Commercial |
$251.30
|
| Rate for Payer: One Health Plan PPO/POS |
$323.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$341.05
|
| Rate for Payer: Three Rivers Provider Network All |
$269.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$315.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$333.87
|
| Rate for Payer: Zelis Auto |
$143.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.50
|
| Rate for Payer: Zelis Worker's Compensation |
$98.01
|
|
|
REMOVAL OF STOMACH, PARTIAL
|
Facility
|
IP
|
$3,056.00
|
|
|
Service Code
|
CPT 43631
|
| Hospital Charge Code |
6143631
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$834.29 |
| Max. Negotiated Rate |
$2,903.20 |
| Rate for Payer: Cash Price |
$1,833.60
|
| Rate for Payer: Cigna Commercial |
$2,597.60
|
| Rate for Payer: First Health Commercial |
$2,750.40
|
| Rate for Payer: First Health Workers Compensation |
$1,179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,750.40
|
| Rate for Payer: GEHA Commercial |
$2,139.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,750.40
|
| Rate for Payer: Multiplan All |
$2,780.96
|
| Rate for Payer: OMNI Networks Commercial |
$2,139.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,750.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,903.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,292.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,842.08
|
| Rate for Payer: Zelis Auto |
$1,222.40
|
| Rate for Payer: Zelis Worker's Compensation |
$834.29
|
|
|
REMOVAL OF SUPPORT IMPLANT
|
Facility
|
OP
|
$1,724.82
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
6120680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$470.88 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,735.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,034.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,735.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,166.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,034.89
|
| Rate for Payer: Cash Price |
$1,034.89
|
| Rate for Payer: Cigna Commercial |
$1,466.10
|
| Rate for Payer: First Health Commercial |
$1,552.34
|
| Rate for Payer: First Health Workers Compensation |
$665.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,552.34
|
| Rate for Payer: GEHA Commercial |
$1,379.86
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,552.34
|
| 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 |
$2,211.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,569.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,207.37
|
| Rate for Payer: One Health Plan PPO/POS |
$1,552.34
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,553.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,211.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,638.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,293.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,211.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,604.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$689.93
|
| 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 |
$470.88
|
|
|
REMOVAL OF SUPPORT IMPLANT
|
Facility
|
IP
|
$1,724.82
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
6120680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$470.88 |
| Max. Negotiated Rate |
$1,638.58 |
| Rate for Payer: Cash Price |
$1,034.89
|
| Rate for Payer: Cigna Commercial |
$1,466.10
|
| Rate for Payer: First Health Commercial |
$1,552.34
|
| Rate for Payer: First Health Workers Compensation |
$665.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,552.34
|
| Rate for Payer: GEHA Commercial |
$1,207.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,552.34
|
| Rate for Payer: Multiplan All |
$1,569.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,207.37
|
| Rate for Payer: One Health Plan PPO/POS |
$1,552.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,638.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,293.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,604.08
|
| Rate for Payer: Zelis Auto |
$689.93
|
| Rate for Payer: Zelis Worker's Compensation |
$470.88
|
|
|
REMOVAL OF SUTURE FROM ANUS
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 46754
|
| Hospital Charge Code |
6146754
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.07 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$223.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$405.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Worker's Compensation |
$158.07
|
|
|
REMOVAL OF SUTURE FROM ANUS
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 46754
|
| Hospital Charge Code |
6146754
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.07 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$223.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$158.07
|
|
