|
REMOVAL OF URETER STONE
|
Facility
|
OP
|
$1,874.00
|
|
|
Service Code
|
CPT 50620
|
| Hospital Charge Code |
6150620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$1,780.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,124.40
|
| Rate for Payer: Cash Price |
$1,124.40
|
| Rate for Payer: Cigna Commercial |
$1,592.90
|
| Rate for Payer: First Health Commercial |
$1,686.60
|
| Rate for Payer: First Health Workers Compensation |
$723.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,686.60
|
| Rate for Payer: GEHA Commercial |
$1,499.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,686.60
|
| Rate for Payer: Humana ChoiceCare |
$487.24
|
| Rate for Payer: Multiplan All |
$1,705.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,124.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,311.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,686.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,780.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,405.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,649.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$468.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,742.82
|
| Rate for Payer: Zelis Auto |
$749.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$937.00
|
| Rate for Payer: Zelis Worker's Compensation |
$511.60
|
|
|
REMOVAL OF URETER STONE
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
CPT 50610
|
| Hospital Charge Code |
6150610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$551.46 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cigna Commercial |
$1,717.00
|
| Rate for Payer: First Health Commercial |
$1,818.00
|
| Rate for Payer: First Health Workers Compensation |
$779.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,818.00
|
| Rate for Payer: GEHA Commercial |
$1,414.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,818.00
|
| Rate for Payer: Multiplan All |
$1,838.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,414.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,818.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,919.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,515.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,878.60
|
| Rate for Payer: Zelis Auto |
$808.00
|
| Rate for Payer: Zelis Worker's Compensation |
$551.46
|
|
|
REMOVAL OF URETER STONE
|
Facility
|
OP
|
$1,839.00
|
|
|
Service Code
|
CPT 50630
|
| Hospital Charge Code |
6150630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$459.75 |
| Max. Negotiated Rate |
$1,747.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,103.40
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cigna Commercial |
$1,563.15
|
| Rate for Payer: First Health Commercial |
$1,655.10
|
| Rate for Payer: First Health Workers Compensation |
$710.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,655.10
|
| Rate for Payer: GEHA Commercial |
$1,471.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,655.10
|
| Rate for Payer: Humana ChoiceCare |
$478.14
|
| Rate for Payer: Multiplan All |
$1,673.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,103.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,287.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,655.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,747.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,379.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,618.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$459.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,710.27
|
| Rate for Payer: Zelis Auto |
$735.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$919.50
|
| Rate for Payer: Zelis Worker's Compensation |
$502.05
|
|
|
REMOVAL OF URETER STONE
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 51060
|
| Hospital Charge Code |
6151060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.05 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: First Health Workers Compensation |
$462.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$327.05
|
|
|
REMOVAL OF URETER STONE
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 51060
|
| Hospital Charge Code |
6151060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.05 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: First Health Workers Compensation |
$462.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Worker's Compensation |
$327.05
|
|
|
REMOVAL OF URETER STONE
|
Facility
|
IP
|
$1,839.00
|
|
|
Service Code
|
CPT 50630
|
| Hospital Charge Code |
6150630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$502.05 |
| Max. Negotiated Rate |
$1,747.05 |
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cigna Commercial |
$1,563.15
|
| Rate for Payer: First Health Commercial |
$1,655.10
|
| Rate for Payer: First Health Workers Compensation |
$710.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,655.10
|
| Rate for Payer: GEHA Commercial |
$1,287.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,655.10
|
| Rate for Payer: Multiplan All |
$1,673.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,287.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,655.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,747.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,379.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,710.27
|
| Rate for Payer: Zelis Auto |
$735.60
|
| Rate for Payer: Zelis Worker's Compensation |
$502.05
|
|
|
REMOVAL OF URETER STONE
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
CPT 50610
|
| Hospital Charge Code |
6150610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cigna Commercial |
$1,717.00
|
| Rate for Payer: First Health Commercial |
$1,818.00
|
| Rate for Payer: First Health Workers Compensation |
$779.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,818.00
|
| Rate for Payer: GEHA Commercial |
$1,616.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,818.00
|
| Rate for Payer: Humana ChoiceCare |
$525.20
|
| Rate for Payer: Multiplan All |
$1,838.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,212.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,414.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,818.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,919.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,515.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,777.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$505.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,878.60
|
| Rate for Payer: Zelis Auto |
$808.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,010.00
|
| Rate for Payer: Zelis Worker's Compensation |
$551.46
|
|
|
REMOVAL OF URETHRA
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 53210
|
| Hospital Charge Code |
6153210
|
|
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 URETHRA
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 53215
|
| Hospital Charge Code |
6153215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$523.61 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| 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 |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| 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 |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,726.20
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,745.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| 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 |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,822.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,438.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,783.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$767.20
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$523.61
|
|
|
REMOVAL OF URETHRA
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 53215
|
| Hospital Charge Code |
6153215
|
|
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 URETHRA
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 53210
|
| Hospital Charge Code |
6153210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| 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 |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| 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 |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| 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 |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| 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 |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$634.40
|
| 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 |
$432.98
|
|
|
REMOVAL OF URETHRA GLAND
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 53250
|
| Hospital Charge Code |
6153250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: First Health Commercial |
$765.00
|
| Rate for Payer: First Health Workers Compensation |
$328.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.00
|
| Rate for Payer: GEHA Commercial |
$680.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.00
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$773.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$595.00
|
| Rate for Payer: One Health Plan PPO/POS |
$765.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$637.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$340.00
|
| 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 |
$232.05
|
|
|
REMOVAL OF URETHRA GLAND
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 53250
|
| Hospital Charge Code |
6153250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: First Health Commercial |
$765.00
|
| Rate for Payer: First Health Workers Compensation |
$328.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.00
|
| Rate for Payer: GEHA Commercial |
$595.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.00
|
| Rate for Payer: Multiplan All |
$773.50
|
| Rate for Payer: OMNI Networks Commercial |
$595.00
|
| Rate for Payer: One Health Plan PPO/POS |
$765.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.50
|
| Rate for Payer: Three Rivers Provider Network All |
$637.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.50
|
| Rate for Payer: Zelis Auto |
$340.00
|
| Rate for Payer: Zelis Worker's Compensation |
$232.05
|
|
|
REMOVAL OF URETHRA GLAND
|
Facility
|
IP
|
$605.46
|
|
|
Service Code
|
CPT 53270
|
| Hospital Charge Code |
6153270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$575.19 |
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cigna Commercial |
$514.64
|
| Rate for Payer: First Health Commercial |
$544.91
|
| Rate for Payer: First Health Workers Compensation |
$233.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.91
|
| Rate for Payer: GEHA Commercial |
$423.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.91
|
| Rate for Payer: Multiplan All |
$550.97
|
| Rate for Payer: OMNI Networks Commercial |
$423.82
|
| Rate for Payer: One Health Plan PPO/POS |
$544.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$575.19
|
| Rate for Payer: Three Rivers Provider Network All |
$454.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$563.08
|
| Rate for Payer: Zelis Auto |
$242.18
|
| Rate for Payer: Zelis Worker's Compensation |
$165.29
|
|
|
REMOVAL OF URETHRA GLAND
|
Facility
|
OP
|
$605.46
|
|
|
Service Code
|
CPT 53270
|
| Hospital Charge Code |
6153270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cigna Commercial |
$514.64
|
| Rate for Payer: First Health Commercial |
$544.91
|
| Rate for Payer: First Health Workers Compensation |
$233.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.91
|
| Rate for Payer: GEHA Commercial |
$484.37
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.91
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$550.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$423.82
|
| Rate for Payer: One Health Plan PPO/POS |
$544.91
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$575.19
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$454.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$563.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$242.18
|
| 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 |
$165.29
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 53230
|
| Hospital Charge Code |
6153230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$870.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 53230
|
| Hospital Charge Code |
6153230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$746.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$995.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT 53235
|
| Hospital Charge Code |
6153235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,105.00
|
| Rate for Payer: First Health Commercial |
$1,170.00
|
| Rate for Payer: First Health Workers Compensation |
$501.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,170.00
|
| Rate for Payer: GEHA Commercial |
$910.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,170.00
|
| Rate for Payer: Multiplan All |
$1,183.00
|
| Rate for Payer: OMNI Networks Commercial |
$910.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,170.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,235.00
|
| Rate for Payer: Three Rivers Provider Network All |
$975.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,209.00
|
| Rate for Payer: Zelis Auto |
$520.00
|
| Rate for Payer: Zelis Worker's Compensation |
$354.90
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
CPT 53235
|
| Hospital Charge Code |
6153235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$780.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,105.00
|
| Rate for Payer: First Health Commercial |
$1,170.00
|
| Rate for Payer: First Health Workers Compensation |
$501.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,170.00
|
| Rate for Payer: GEHA Commercial |
$1,040.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,170.00
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,183.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$910.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,170.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,235.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$975.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,209.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$520.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$354.90
|
|
|
REMOVAL OF WRIST BONE
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
6125210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$690.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: Zelis Auto |
$394.40
|
| Rate for Payer: Zelis Worker's Compensation |
$269.18
|
|
|
REMOVAL OF WRIST BONE
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
6125210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.18 |
| 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 |
$591.60
|
| 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 |
$591.60
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$788.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| 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 |
$897.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| 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 |
$936.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| 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 |
$916.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$394.40
|
| 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 |
$269.18
|
|
|
REMOVAL OF WRIST BONES
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 25215
|
| Hospital Charge Code |
6125215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$342.62 |
| 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 |
$753.00
|
| 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 |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$1,066.75
|
| Rate for Payer: First Health Commercial |
$1,129.50
|
| Rate for Payer: First Health Workers Compensation |
$484.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,129.50
|
| Rate for Payer: GEHA Commercial |
$1,004.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,129.50
|
| 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 |
$1,142.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$878.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,129.50
|
| 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 |
$1,192.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$941.25
|
| 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 |
$1,167.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$502.00
|
| 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 |
$342.62
|
|
|
REMOVAL OF WRIST BONES
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 25215
|
| Hospital Charge Code |
6125215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$342.62 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$1,066.75
|
| Rate for Payer: First Health Commercial |
$1,129.50
|
| Rate for Payer: First Health Workers Compensation |
$484.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,129.50
|
| Rate for Payer: GEHA Commercial |
$878.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,129.50
|
| Rate for Payer: Multiplan All |
$1,142.05
|
| Rate for Payer: OMNI Networks Commercial |
$878.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,129.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,192.25
|
| Rate for Payer: Three Rivers Provider Network All |
$941.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,167.15
|
| Rate for Payer: Zelis Auto |
$502.00
|
| Rate for Payer: Zelis Worker's Compensation |
$342.62
|
|
|
REMOVAL OF WRIST LESION
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 25130
|
| Hospital Charge Code |
6125130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.97 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$765.85
|
| Rate for Payer: First Health Commercial |
$810.90
|
| Rate for Payer: First Health Workers Compensation |
$347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.90
|
| Rate for Payer: GEHA Commercial |
$630.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.90
|
| Rate for Payer: Multiplan All |
$819.91
|
| Rate for Payer: OMNI Networks Commercial |
$630.70
|
| Rate for Payer: One Health Plan PPO/POS |
$810.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.95
|
| Rate for Payer: Three Rivers Provider Network All |
$675.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.93
|
| Rate for Payer: Zelis Auto |
$360.40
|
| Rate for Payer: Zelis Worker's Compensation |
$245.97
|
|
|
REMOVAL OF WRIST LESION
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 25130
|
| Hospital Charge Code |
6125130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.97 |
| 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 |
$540.60
|
| 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 |
$540.60
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$765.85
|
| Rate for Payer: First Health Commercial |
$810.90
|
| Rate for Payer: First Health Workers Compensation |
$347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.90
|
| Rate for Payer: GEHA Commercial |
$720.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.90
|
| 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 |
$819.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$630.70
|
| Rate for Payer: One Health Plan PPO/POS |
$810.90
|
| 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 |
$855.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$675.75
|
| 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 |
$837.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$360.40
|
| 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 |
$245.97
|
|
