|
REMOVE ANAL FIST INTER
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT 46275
|
| Hospital Charge Code |
6146275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.96 |
| 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 |
$507.60
|
| 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 |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$719.10
|
| Rate for Payer: First Health Commercial |
$761.40
|
| Rate for Payer: First Health Workers Compensation |
$326.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$761.40
|
| Rate for Payer: GEHA Commercial |
$676.80
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$761.40
|
| 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 |
$769.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$592.20
|
| Rate for Payer: One Health Plan PPO/POS |
$761.40
|
| 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 |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$634.50
|
| 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 |
$786.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$338.40
|
| 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 |
$230.96
|
|
|
REMOVE ANAL FIST SUBQ
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 46270
|
| Hospital Charge Code |
6146270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| 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 |
$601.80
|
| 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 |
$601.80
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$802.40
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| 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 |
$912.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| 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 |
$952.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| 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 |
$932.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$401.20
|
| 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 |
$273.82
|
|
|
REMOVE ANAL FIST SUBQ
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 46270
|
| Hospital Charge Code |
6146270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$702.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
REMOVE ANEURYSM SINUS
|
Facility
|
IP
|
$6,873.00
|
|
|
Service Code
|
CPT 61613
|
| Hospital Charge Code |
6161613
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,876.33 |
| Max. Negotiated Rate |
$6,529.35 |
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cigna Commercial |
$5,842.05
|
| Rate for Payer: First Health Commercial |
$6,185.70
|
| Rate for Payer: First Health Workers Compensation |
$2,653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,185.70
|
| Rate for Payer: GEHA Commercial |
$4,811.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,185.70
|
| Rate for Payer: Multiplan All |
$6,254.43
|
| Rate for Payer: OMNI Networks Commercial |
$4,811.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,185.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,529.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,154.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,391.89
|
| Rate for Payer: Zelis Auto |
$2,749.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,876.33
|
|
|
REMOVE ANEURYSM SINUS
|
Facility
|
OP
|
$6,873.00
|
|
|
Service Code
|
CPT 61613
|
| Hospital Charge Code |
6161613
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,718.25 |
| Max. Negotiated Rate |
$6,529.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cigna Commercial |
$5,842.05
|
| Rate for Payer: First Health Commercial |
$6,185.70
|
| Rate for Payer: First Health Workers Compensation |
$2,653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,185.70
|
| Rate for Payer: GEHA Commercial |
$5,498.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,185.70
|
| Rate for Payer: Humana ChoiceCare |
$1,786.98
|
| Rate for Payer: Multiplan All |
$6,254.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,123.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,811.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,185.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,529.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,154.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,048.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,718.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,391.89
|
| Rate for Payer: Zelis Auto |
$2,749.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,436.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,876.33
|
|
|
REMOVE ANKLE JOINT LINING
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 27625
|
| Hospital Charge Code |
6127625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.33 |
| Max. Negotiated Rate |
$1,139.05 |
| Rate for Payer: Cash Price |
$719.40
|
| Rate for Payer: Cigna Commercial |
$1,019.15
|
| Rate for Payer: First Health Commercial |
$1,079.10
|
| Rate for Payer: First Health Workers Compensation |
$462.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,079.10
|
| Rate for Payer: GEHA Commercial |
$839.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,079.10
|
| Rate for Payer: Multiplan All |
$1,091.09
|
| Rate for Payer: OMNI Networks Commercial |
$839.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,079.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,139.05
|
| Rate for Payer: Three Rivers Provider Network All |
$899.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,115.07
|
| Rate for Payer: Zelis Auto |
$479.60
|
| Rate for Payer: Zelis Worker's Compensation |
$327.33
|
|
|
REMOVE ANKLE JOINT LINING
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 27625
|
| Hospital Charge Code |
6127625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.33 |
| 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 |
$719.40
|
| 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 |
$719.40
|
| Rate for Payer: Cash Price |
$719.40
|
| Rate for Payer: Cigna Commercial |
$1,019.15
|
| Rate for Payer: First Health Commercial |
$1,079.10
|
| Rate for Payer: First Health Workers Compensation |
$462.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,079.10
|
| Rate for Payer: GEHA Commercial |
$959.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,079.10
|
| 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 |
$1,091.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$839.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,079.10
|
| 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 |
$1,139.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$899.25
|
| 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 |
$1,115.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$479.60
|
| 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 |
$327.33
|
|
|
REMOVE ANKLE JOINT LINING
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 27626
|
| Hospital Charge Code |
6127626
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.62 |
| 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 |
$759.60
|
| 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 |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$1,012.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| 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 |
$1,152.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| 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 |
$1,202.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| 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 |
$1,177.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$506.40
|
| 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 |
$345.62
|
|
|
REMOVE ANKLE JOINT LINING
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 27626
|
| Hospital Charge Code |
6127626
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.62 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$886.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
REMOVE ARMPIT LYMPH NODES
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT 38740
|
| Hospital Charge Code |
6138740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.85 |
| 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 |
$870.00
|
| 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 |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,232.50
|
| Rate for Payer: First Health Commercial |
$1,305.00
|
| Rate for Payer: First Health Workers Compensation |
$559.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,305.00
|
| Rate for Payer: GEHA Commercial |
$1,160.00
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,305.00
|
| 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 |
$1,319.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,305.00
|
| 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 |
$1,377.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,087.50
|
| 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 |
$1,348.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$580.00
|
| 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 |
$395.85
|
|
|
REMOVE ARMPIT LYMPH NODES
|
Facility
|
IP
|
$1,834.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
6138745
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$500.68 |
| Max. Negotiated Rate |
$1,742.30 |
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cigna Commercial |
$1,558.90
|
| Rate for Payer: First Health Commercial |
$1,650.60
|
| Rate for Payer: First Health Workers Compensation |
$708.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,650.60
|
| Rate for Payer: GEHA Commercial |
$1,283.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,650.60
|
| Rate for Payer: Multiplan All |
$1,668.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,283.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,650.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,742.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,375.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,705.62
|
| Rate for Payer: Zelis Auto |
$733.60
|
| Rate for Payer: Zelis Worker's Compensation |
$500.68
|
|
|
REMOVE ARMPIT LYMPH NODES
|
Facility
|
OP
|
$1,834.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
6138745
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$500.68 |
| 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 |
$1,100.40
|
| 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 |
$1,100.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cigna Commercial |
$1,558.90
|
| Rate for Payer: First Health Commercial |
$1,650.60
|
| Rate for Payer: First Health Workers Compensation |
$708.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,650.60
|
| Rate for Payer: GEHA Commercial |
$1,467.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,650.60
|
| 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 |
$1,668.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,283.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,650.60
|
| 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 |
$1,742.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,375.50
|
| 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 |
$1,705.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$733.60
|
| 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 |
$500.68
|
|
|
REMOVE ARMPIT LYMPH NODES
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT 38740
|
| Hospital Charge Code |
6138740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.85 |
| Max. Negotiated Rate |
$1,377.50 |
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,232.50
|
| Rate for Payer: First Health Commercial |
$1,305.00
|
| Rate for Payer: First Health Workers Compensation |
$559.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,305.00
|
| Rate for Payer: GEHA Commercial |
$1,015.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,305.00
|
| Rate for Payer: Multiplan All |
$1,319.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,305.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,377.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,087.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,348.50
|
| Rate for Payer: Zelis Auto |
$580.00
|
| Rate for Payer: Zelis Worker's Compensation |
$395.85
|
|
|
REMOVE BLADDER/CREATE POUCH
|
Facility
|
OP
|
$4,867.00
|
|
|
Service Code
|
CPT 51596
|
| Hospital Charge Code |
6151596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,216.75 |
| Max. Negotiated Rate |
$4,623.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,920.20
|
| Rate for Payer: Cash Price |
$2,920.20
|
| Rate for Payer: Cigna Commercial |
$4,136.95
|
| Rate for Payer: First Health Commercial |
$4,380.30
|
| Rate for Payer: First Health Workers Compensation |
$1,879.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,380.30
|
| Rate for Payer: GEHA Commercial |
$3,893.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,380.30
|
| Rate for Payer: Humana ChoiceCare |
$1,265.42
|
| Rate for Payer: Multiplan All |
$4,428.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,920.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,406.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,380.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,623.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,650.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,282.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,526.31
|
| Rate for Payer: Zelis Auto |
$1,946.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,433.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,328.69
|
|
|
REMOVE BLADDER/CREATE POUCH
|
Facility
|
IP
|
$4,867.00
|
|
|
Service Code
|
CPT 51596
|
| Hospital Charge Code |
6151596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,328.69 |
| Max. Negotiated Rate |
$4,623.65 |
| Rate for Payer: Cash Price |
$2,920.20
|
| Rate for Payer: Cigna Commercial |
$4,136.95
|
| Rate for Payer: First Health Commercial |
$4,380.30
|
| Rate for Payer: First Health Workers Compensation |
$1,879.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,380.30
|
| Rate for Payer: GEHA Commercial |
$3,406.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,380.30
|
| Rate for Payer: Multiplan All |
$4,428.97
|
| Rate for Payer: OMNI Networks Commercial |
$3,406.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,380.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,623.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,526.31
|
| Rate for Payer: Zelis Auto |
$1,946.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,328.69
|
|
|
REMOVE BLADDER/REVISE TRACT
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
CPT 51590
|
| Hospital Charge Code |
6151590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,001.25 |
| Max. Negotiated Rate |
$3,804.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,403.00
|
| Rate for Payer: Cash Price |
$2,403.00
|
| Rate for Payer: Cigna Commercial |
$3,404.25
|
| Rate for Payer: First Health Commercial |
$3,604.50
|
| Rate for Payer: First Health Workers Compensation |
$1,546.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,604.50
|
| Rate for Payer: GEHA Commercial |
$3,204.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,604.50
|
| Rate for Payer: Humana ChoiceCare |
$1,041.30
|
| Rate for Payer: Multiplan All |
$3,644.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,403.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,803.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,604.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,804.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,003.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,524.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,001.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,724.65
|
| Rate for Payer: Zelis Auto |
$1,602.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,002.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,093.37
|
|
|
REMOVE BLADDER/REVISE TRACT
|
Facility
|
IP
|
$4,531.00
|
|
|
Service Code
|
CPT 51595
|
| Hospital Charge Code |
6151595
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,236.96 |
| Max. Negotiated Rate |
$4,304.45 |
| Rate for Payer: Cash Price |
$2,718.60
|
| Rate for Payer: Cigna Commercial |
$3,851.35
|
| Rate for Payer: First Health Commercial |
$4,077.90
|
| Rate for Payer: First Health Workers Compensation |
$1,749.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,077.90
|
| Rate for Payer: GEHA Commercial |
$3,171.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,077.90
|
| Rate for Payer: Multiplan All |
$4,123.21
|
| Rate for Payer: OMNI Networks Commercial |
$3,171.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,077.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,304.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,398.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,213.83
|
| Rate for Payer: Zelis Auto |
$1,812.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,236.96
|
|
|
REMOVE BLADDER/REVISE TRACT
|
Facility
|
OP
|
$3,919.00
|
|
|
Service Code
|
CPT 51580
|
| Hospital Charge Code |
6151580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$979.75 |
| Max. Negotiated Rate |
$3,723.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,351.40
|
| Rate for Payer: Cash Price |
$2,351.40
|
| Rate for Payer: Cigna Commercial |
$3,331.15
|
| Rate for Payer: First Health Commercial |
$3,527.10
|
| Rate for Payer: First Health Workers Compensation |
$1,513.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,527.10
|
| Rate for Payer: GEHA Commercial |
$3,135.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,527.10
|
| Rate for Payer: Humana ChoiceCare |
$1,018.94
|
| Rate for Payer: Multiplan All |
$3,566.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,351.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,743.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,527.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,723.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,939.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,448.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$979.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,644.67
|
| Rate for Payer: Zelis Auto |
$1,567.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,959.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,069.89
|
|
|
REMOVE BLADDER/REVISE TRACT
|
Facility
|
OP
|
$4,531.00
|
|
|
Service Code
|
CPT 51595
|
| Hospital Charge Code |
6151595
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,132.75 |
| Max. Negotiated Rate |
$4,304.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,718.60
|
| Rate for Payer: Cash Price |
$2,718.60
|
| Rate for Payer: Cigna Commercial |
$3,851.35
|
| Rate for Payer: First Health Commercial |
$4,077.90
|
| Rate for Payer: First Health Workers Compensation |
$1,749.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,077.90
|
| Rate for Payer: GEHA Commercial |
$3,624.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,077.90
|
| Rate for Payer: Humana ChoiceCare |
$1,178.06
|
| Rate for Payer: Multiplan All |
$4,123.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,718.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,171.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,077.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,304.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,398.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,987.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,132.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,213.83
|
| Rate for Payer: Zelis Auto |
$1,812.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,265.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,236.96
|
|
|
REMOVE BLADDER/REVISE TRACT
|
Facility
|
IP
|
$4,005.00
|
|
|
Service Code
|
CPT 51590
|
| Hospital Charge Code |
6151590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,093.37 |
| Max. Negotiated Rate |
$3,804.75 |
| Rate for Payer: Cash Price |
$2,403.00
|
| Rate for Payer: Cigna Commercial |
$3,404.25
|
| Rate for Payer: First Health Commercial |
$3,604.50
|
| Rate for Payer: First Health Workers Compensation |
$1,546.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,604.50
|
| Rate for Payer: GEHA Commercial |
$2,803.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,604.50
|
| Rate for Payer: Multiplan All |
$3,644.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,803.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,604.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,804.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,003.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,724.65
|
| Rate for Payer: Zelis Auto |
$1,602.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,093.37
|
|
|
REMOVE BLADDER/REVISE TRACT
|
Facility
|
IP
|
$3,919.00
|
|
|
Service Code
|
CPT 51580
|
| Hospital Charge Code |
6151580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,069.89 |
| Max. Negotiated Rate |
$3,723.05 |
| Rate for Payer: Cash Price |
$2,351.40
|
| Rate for Payer: Cigna Commercial |
$3,331.15
|
| Rate for Payer: First Health Commercial |
$3,527.10
|
| Rate for Payer: First Health Workers Compensation |
$1,513.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,527.10
|
| Rate for Payer: GEHA Commercial |
$2,743.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,527.10
|
| Rate for Payer: Multiplan All |
$3,566.29
|
| Rate for Payer: OMNI Networks Commercial |
$2,743.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,527.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,723.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,939.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,644.67
|
| Rate for Payer: Zelis Auto |
$1,567.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,069.89
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
6152317
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: First Health Workers Compensation |
$348.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| 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 |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$361.20
|
| 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 |
$246.52
|
|
|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
6152317
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$857.85 |
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: First Health Workers Compensation |
$348.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$632.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: Zelis Auto |
$361.20
|
| Rate for Payer: Zelis Worker's Compensation |
$246.52
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 52318
|
| Hospital Charge Code |
6152318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| 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 |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| 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 |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| 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 |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| 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 |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$394.40
|
| 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 |
$269.18
|
|
|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 52318
|
| Hospital Charge Code |
6152318
|
|
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
|
|
