|
REMOVAL OF TAIL BONE
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT 27080
|
| Hospital Charge Code |
6127080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.74 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: First Health Workers Compensation |
$406.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$843.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$421.60
|
| 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 |
$287.74
|
|
|
REMOVAL OF TAIL BONE
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT 27080
|
| Hospital Charge Code |
6127080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.74 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: First Health Workers Compensation |
$406.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$737.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Worker's Compensation |
$287.74
|
|
|
REMOVAL OF TAIL BONE ULCER
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 15922
|
| Hospital Charge Code |
6115922
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$951.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$612.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,268.80
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$432.98
|
|
|
REMOVAL OF TAIL BONE ULCER
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 15922
|
| Hospital Charge Code |
6115922
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$1,506.70 |
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$612.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,110.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Worker's Compensation |
$432.98
|
|
|
REMOVAL OF TAIL BONE ULCER
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 15920
|
| Hospital Charge Code |
6115920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$743.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$1,053.15
|
| Rate for Payer: First Health Commercial |
$1,115.10
|
| Rate for Payer: First Health Workers Compensation |
$478.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,115.10
|
| Rate for Payer: GEHA Commercial |
$991.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,115.10
|
| 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 |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,127.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$867.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,115.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,177.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$929.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,152.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$495.60
|
| 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 |
$338.25
|
|
|
REMOVAL OF TAIL BONE ULCER
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 15920
|
| Hospital Charge Code |
6115920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$1,053.15
|
| Rate for Payer: First Health Commercial |
$1,115.10
|
| Rate for Payer: First Health Workers Compensation |
$478.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,115.10
|
| Rate for Payer: GEHA Commercial |
$867.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,115.10
|
| Rate for Payer: Multiplan All |
$1,127.49
|
| Rate for Payer: OMNI Networks Commercial |
$867.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,115.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,177.05
|
| Rate for Payer: Three Rivers Provider Network All |
$929.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,152.27
|
| Rate for Payer: Zelis Auto |
$495.60
|
| Rate for Payer: Zelis Worker's Compensation |
$338.25
|
|
|
REMOVAL OF TENDON FOR GRAFT
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 20924
|
| Hospital Charge Code |
6120924
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$825.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$281.74
|
|
|
REMOVAL OF TENDON FOR GRAFT
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 20924
|
| Hospital Charge Code |
6120924
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Worker's Compensation |
$281.74
|
|
|
REMOVAL OF TENDON LESION
|
Facility
|
OP
|
$933.00
|
|
|
Service Code
|
CPT 27630
|
| Hospital Charge Code |
6127630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.71 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$746.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$849.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$867.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$373.20
|
| 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 |
$254.71
|
|
|
REMOVAL OF TENDON LESION
|
Facility
|
IP
|
$933.00
|
|
|
Service Code
|
CPT 27630
|
| Hospital Charge Code |
6127630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.71 |
| Max. Negotiated Rate |
$886.35 |
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$653.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| Rate for Payer: Multiplan All |
$849.03
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$867.69
|
| Rate for Payer: Zelis Auto |
$373.20
|
| Rate for Payer: Zelis Worker's Compensation |
$254.71
|
|
|
REMOVAL OF TESTIS
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 54520
|
| Hospital Charge Code |
6154520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.23 |
| 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 |
$501.60
|
| 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 |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$668.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| 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 |
$760.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| 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 |
$794.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| 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 |
$777.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$334.40
|
| 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 |
$228.23
|
|
|
REMOVAL OF TESTIS
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 54520
|
| Hospital Charge Code |
6154520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$585.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: Zelis Auto |
$334.40
|
| Rate for Payer: Zelis Worker's Compensation |
$228.23
|
|
|
REMOVAL OF TESTIS
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 54530
|
| Hospital Charge Code |
6154530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$283.10 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$881.45
|
| Rate for Payer: First Health Commercial |
$933.30
|
| Rate for Payer: First Health Workers Compensation |
$400.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$933.30
|
| Rate for Payer: GEHA Commercial |
$829.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$933.30
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$943.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$725.90
|
| Rate for Payer: One Health Plan PPO/POS |
$933.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$985.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$777.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$964.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$414.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$283.10
|
|
|
REMOVAL OF TESTIS
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 54530
|
| Hospital Charge Code |
6154530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$283.10 |
| Max. Negotiated Rate |
$985.15 |
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$881.45
|
| Rate for Payer: First Health Commercial |
$933.30
|
| Rate for Payer: First Health Workers Compensation |
$400.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$933.30
|
| Rate for Payer: GEHA Commercial |
$725.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$933.30
|
| Rate for Payer: Multiplan All |
$943.67
|
| Rate for Payer: OMNI Networks Commercial |
$725.90
|
| Rate for Payer: One Health Plan PPO/POS |
$933.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$985.15
|
| Rate for Payer: Three Rivers Provider Network All |
$777.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$964.41
|
| Rate for Payer: Zelis Auto |
$414.80
|
| Rate for Payer: Zelis Worker's Compensation |
$283.10
|
|
|
REMOVAL OF THYMUS GLAND
|
Facility
|
IP
|
$2,865.00
|
|
|
Service Code
|
CPT 60522
|
| Hospital Charge Code |
6160522
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$782.14 |
| Max. Negotiated Rate |
$2,721.75 |
| Rate for Payer: Cash Price |
$1,719.00
|
| Rate for Payer: Cigna Commercial |
$2,435.25
|
| Rate for Payer: First Health Commercial |
$2,578.50
|
| Rate for Payer: First Health Workers Compensation |
$1,106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,578.50
|
| Rate for Payer: GEHA Commercial |
$2,005.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,578.50
|
| Rate for Payer: Multiplan All |
$2,607.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,005.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,578.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,721.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,148.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,664.45
|
| Rate for Payer: Zelis Auto |
$1,146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$782.14
|
|
|
REMOVAL OF THYMUS GLAND
|
Facility
|
OP
|
$2,865.00
|
|
|
Service Code
|
CPT 60522
|
| Hospital Charge Code |
6160522
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$716.25 |
| Max. Negotiated Rate |
$2,721.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,719.00
|
| Rate for Payer: Cash Price |
$1,719.00
|
| Rate for Payer: Cigna Commercial |
$2,435.25
|
| Rate for Payer: First Health Commercial |
$2,578.50
|
| Rate for Payer: First Health Workers Compensation |
$1,106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,578.50
|
| Rate for Payer: GEHA Commercial |
$2,292.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,578.50
|
| Rate for Payer: Humana ChoiceCare |
$744.90
|
| Rate for Payer: Multiplan All |
$2,607.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,719.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,005.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,578.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,721.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,148.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,521.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$716.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,664.45
|
| Rate for Payer: Zelis Auto |
$1,146.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,432.50
|
| Rate for Payer: Zelis Worker's Compensation |
$782.14
|
|
|
REMOVAL OF THYMUS GLAND
|
Facility
|
IP
|
$2,367.00
|
|
|
Service Code
|
CPT 60521
|
| Hospital Charge Code |
6160521
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$646.19 |
| Max. Negotiated Rate |
$2,248.65 |
| Rate for Payer: Cash Price |
$1,420.20
|
| Rate for Payer: Cigna Commercial |
$2,011.95
|
| Rate for Payer: First Health Commercial |
$2,130.30
|
| Rate for Payer: First Health Workers Compensation |
$913.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,130.30
|
| Rate for Payer: GEHA Commercial |
$1,656.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,130.30
|
| Rate for Payer: Multiplan All |
$2,153.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,656.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,130.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,248.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,775.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,201.31
|
| Rate for Payer: Zelis Auto |
$946.80
|
| Rate for Payer: Zelis Worker's Compensation |
$646.19
|
|
|
REMOVAL OF THYMUS GLAND
|
Facility
|
IP
|
$2,188.00
|
|
|
Service Code
|
CPT 60520
|
| Hospital Charge Code |
6160520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.32 |
| Max. Negotiated Rate |
$2,078.60 |
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cigna Commercial |
$1,859.80
|
| Rate for Payer: First Health Commercial |
$1,969.20
|
| Rate for Payer: First Health Workers Compensation |
$844.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,969.20
|
| Rate for Payer: GEHA Commercial |
$1,531.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,969.20
|
| Rate for Payer: Multiplan All |
$1,991.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,531.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,969.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,078.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,034.84
|
| Rate for Payer: Zelis Auto |
$875.20
|
| Rate for Payer: Zelis Worker's Compensation |
$597.32
|
|
|
REMOVAL OF THYMUS GLAND
|
Facility
|
OP
|
$2,188.00
|
|
|
Service Code
|
CPT 60520
|
| Hospital Charge Code |
6160520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.32 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,312.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cigna Commercial |
$1,859.80
|
| Rate for Payer: First Health Commercial |
$1,969.20
|
| Rate for Payer: First Health Workers Compensation |
$844.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,969.20
|
| Rate for Payer: GEHA Commercial |
$1,750.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,969.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,991.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,531.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,969.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,078.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,034.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$875.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$597.32
|
|
|
REMOVAL OF THYMUS GLAND
|
Facility
|
OP
|
$2,367.00
|
|
|
Service Code
|
CPT 60521
|
| Hospital Charge Code |
6160521
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$591.75 |
| Max. Negotiated Rate |
$2,248.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,420.20
|
| Rate for Payer: Cash Price |
$1,420.20
|
| Rate for Payer: Cigna Commercial |
$2,011.95
|
| Rate for Payer: First Health Commercial |
$2,130.30
|
| Rate for Payer: First Health Workers Compensation |
$913.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,130.30
|
| Rate for Payer: GEHA Commercial |
$1,893.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,130.30
|
| Rate for Payer: Humana ChoiceCare |
$615.42
|
| Rate for Payer: Multiplan All |
$2,153.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,420.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,656.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,130.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,248.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,775.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,082.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$591.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,201.31
|
| Rate for Payer: Zelis Auto |
$946.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,183.50
|
| Rate for Payer: Zelis Worker's Compensation |
$646.19
|
|
|
REMOVAL OF THYROID
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 60240
|
| Hospital Charge Code |
6160240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$523.61 |
| Max. Negotiated Rate |
$1,822.10 |
| Rate for Payer: Cash Price |
$1,150.80
|
| Rate for Payer: Cigna Commercial |
$1,630.30
|
| Rate for Payer: First Health Commercial |
$1,726.20
|
| Rate for Payer: First Health Workers Compensation |
$740.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,726.20
|
| Rate for Payer: GEHA Commercial |
$1,342.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,726.20
|
| Rate for Payer: Multiplan All |
$1,745.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,342.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,726.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,822.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,438.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,783.74
|
| Rate for Payer: Zelis Auto |
$767.20
|
| Rate for Payer: Zelis Worker's Compensation |
$523.61
|
|
|
REMOVAL OF THYROID
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 60240
|
| Hospital Charge Code |
6160240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$523.61 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,150.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$1,150.80
|
| Rate for Payer: Cash Price |
$1,150.80
|
| Rate for Payer: Cigna Commercial |
$1,630.30
|
| Rate for Payer: First Health Commercial |
$1,726.20
|
| Rate for Payer: First Health Workers Compensation |
$740.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,726.20
|
| Rate for Payer: GEHA Commercial |
$1,534.40
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,726.20
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,745.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,342.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,726.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,822.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,438.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,783.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$767.20
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$523.61
|
|
|
REMOVAL OF THYROID
|
Facility
|
IP
|
$2,209.00
|
|
|
Service Code
|
CPT 60271
|
| Hospital Charge Code |
6160271
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.06 |
| Max. Negotiated Rate |
$2,098.55 |
| Rate for Payer: Cash Price |
$1,325.40
|
| Rate for Payer: Cigna Commercial |
$1,877.65
|
| Rate for Payer: First Health Commercial |
$1,988.10
|
| Rate for Payer: First Health Workers Compensation |
$852.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,988.10
|
| Rate for Payer: GEHA Commercial |
$1,546.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,988.10
|
| Rate for Payer: Multiplan All |
$2,010.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,546.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,988.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,098.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,656.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,054.37
|
| Rate for Payer: Zelis Auto |
$883.60
|
| Rate for Payer: Zelis Worker's Compensation |
$603.06
|
|
|
REMOVAL OF THYROID
|
Facility
|
OP
|
$2,863.00
|
|
|
Service Code
|
CPT 60270
|
| Hospital Charge Code |
6160270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$715.75 |
| Max. Negotiated Rate |
$2,719.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,717.80
|
| Rate for Payer: Cash Price |
$1,717.80
|
| Rate for Payer: Cigna Commercial |
$2,433.55
|
| Rate for Payer: First Health Commercial |
$2,576.70
|
| Rate for Payer: First Health Workers Compensation |
$1,105.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,576.70
|
| Rate for Payer: GEHA Commercial |
$2,290.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,576.70
|
| Rate for Payer: Humana ChoiceCare |
$744.38
|
| Rate for Payer: Multiplan All |
$2,605.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,717.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,004.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,576.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,719.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,147.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,519.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$715.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,662.59
|
| Rate for Payer: Zelis Auto |
$1,145.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,431.50
|
| Rate for Payer: Zelis Worker's Compensation |
$781.60
|
|
|
REMOVAL OF THYROID
|
Facility
|
OP
|
$2,209.00
|
|
|
Service Code
|
CPT 60271
|
| Hospital Charge Code |
6160271
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.06 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,325.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,325.40
|
| Rate for Payer: Cash Price |
$1,325.40
|
| Rate for Payer: Cigna Commercial |
$1,877.65
|
| Rate for Payer: First Health Commercial |
$1,988.10
|
| Rate for Payer: First Health Workers Compensation |
$852.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,988.10
|
| Rate for Payer: GEHA Commercial |
$1,767.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,988.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,010.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,546.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,988.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,098.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,656.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,054.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$883.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$603.06
|
|
