|
REMOVE DIGIT NERVE LESION
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
CPT 64776
|
| Hospital Charge Code |
6164776
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.73 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$599.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna Commercial |
$849.15
|
| Rate for Payer: First Health Commercial |
$899.10
|
| Rate for Payer: First Health Workers Compensation |
$385.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$899.10
|
| Rate for Payer: GEHA Commercial |
$799.20
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$899.10
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$909.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$699.30
|
| Rate for Payer: One Health Plan PPO/POS |
$899.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$949.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$749.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$929.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$399.60
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$272.73
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
6169145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$599.45 |
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$536.35
|
| Rate for Payer: First Health Commercial |
$567.90
|
| Rate for Payer: First Health Workers Compensation |
$243.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$567.90
|
| Rate for Payer: GEHA Commercial |
$441.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$567.90
|
| Rate for Payer: Multiplan All |
$574.21
|
| Rate for Payer: OMNI Networks Commercial |
$441.70
|
| Rate for Payer: One Health Plan PPO/POS |
$567.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$599.45
|
| Rate for Payer: Three Rivers Provider Network All |
$473.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$586.83
|
| Rate for Payer: Zelis Auto |
$252.40
|
| Rate for Payer: Zelis Worker's Compensation |
$172.26
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
6169145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$378.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$536.35
|
| Rate for Payer: First Health Commercial |
$567.90
|
| Rate for Payer: First Health Workers Compensation |
$243.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$567.90
|
| Rate for Payer: GEHA Commercial |
$504.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$567.90
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$574.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$441.70
|
| Rate for Payer: One Health Plan PPO/POS |
$567.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$599.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$473.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$586.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$252.40
|
| 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 |
$172.26
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
CPT 69140
|
| Hospital Charge Code |
6169140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.21 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,055.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$1,495.15
|
| Rate for Payer: First Health Commercial |
$1,583.10
|
| Rate for Payer: First Health Workers Compensation |
$679.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,583.10
|
| Rate for Payer: GEHA Commercial |
$1,407.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,583.10
|
| 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 |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,600.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,231.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,583.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,671.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,319.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,635.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$703.60
|
| 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 |
$480.21
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
CPT 69140
|
| Hospital Charge Code |
6169140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.21 |
| Max. Negotiated Rate |
$1,671.05 |
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$1,495.15
|
| Rate for Payer: First Health Commercial |
$1,583.10
|
| Rate for Payer: First Health Workers Compensation |
$679.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,583.10
|
| Rate for Payer: GEHA Commercial |
$1,231.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,583.10
|
| Rate for Payer: Multiplan All |
$1,600.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,231.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,583.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,671.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,319.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,635.87
|
| Rate for Payer: Zelis Auto |
$703.60
|
| Rate for Payer: Zelis Worker's Compensation |
$480.21
|
|
|
REMOVE EAR LESION
|
Facility
|
IP
|
$5,004.00
|
|
|
Service Code
|
CPT 69554
|
| Hospital Charge Code |
6169554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,366.09 |
| Max. Negotiated Rate |
$4,753.80 |
| Rate for Payer: Cash Price |
$3,002.40
|
| Rate for Payer: Cigna Commercial |
$4,253.40
|
| Rate for Payer: First Health Commercial |
$4,503.60
|
| Rate for Payer: First Health Workers Compensation |
$1,932.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,503.60
|
| Rate for Payer: GEHA Commercial |
$3,502.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,503.60
|
| Rate for Payer: Multiplan All |
$4,553.64
|
| Rate for Payer: OMNI Networks Commercial |
$3,502.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,503.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,753.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,753.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,653.72
|
| Rate for Payer: Zelis Auto |
$2,001.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,366.09
|
|
|
REMOVE EAR LESION
|
Facility
|
OP
|
$5,004.00
|
|
|
Service Code
|
CPT 69554
|
| Hospital Charge Code |
6169554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,251.00 |
| Max. Negotiated Rate |
$4,753.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,002.40
|
| Rate for Payer: Cash Price |
$3,002.40
|
| Rate for Payer: Cigna Commercial |
$4,253.40
|
| Rate for Payer: First Health Commercial |
$4,503.60
|
| Rate for Payer: First Health Workers Compensation |
$1,932.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,503.60
|
| Rate for Payer: GEHA Commercial |
$4,003.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,503.60
|
| Rate for Payer: Humana ChoiceCare |
$1,301.04
|
| Rate for Payer: Multiplan All |
$4,553.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,002.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,502.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,503.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,753.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,753.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,403.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,251.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,653.72
|
| Rate for Payer: Zelis Auto |
$2,001.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,502.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,366.09
|
|
|
REMOVE EAR LESION
|
Facility
|
IP
|
$3,186.00
|
|
|
Service Code
|
CPT 69552
|
| Hospital Charge Code |
6169552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$869.78 |
| Max. Negotiated Rate |
$3,026.70 |
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cigna Commercial |
$2,708.10
|
| Rate for Payer: First Health Commercial |
$2,867.40
|
| Rate for Payer: First Health Workers Compensation |
$1,230.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,867.40
|
| Rate for Payer: GEHA Commercial |
$2,230.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,867.40
|
| Rate for Payer: Multiplan All |
$2,899.26
|
| Rate for Payer: OMNI Networks Commercial |
$2,230.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,867.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,026.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,389.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,962.98
|
| Rate for Payer: Zelis Auto |
$1,274.40
|
| Rate for Payer: Zelis Worker's Compensation |
$869.78
|
|
|
REMOVE EAR LESION
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 69540
|
| Hospital Charge Code |
6169540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$307.20
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
REMOVE EAR LESION
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 69550
|
| Hospital Charge Code |
6169550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.39 |
| Max. Negotiated Rate |
$1,998.80 |
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$1,788.40
|
| Rate for Payer: First Health Commercial |
$1,893.60
|
| Rate for Payer: First Health Workers Compensation |
$812.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,893.60
|
| Rate for Payer: GEHA Commercial |
$1,472.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,893.60
|
| Rate for Payer: Multiplan All |
$1,914.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,472.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,893.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,998.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,578.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,956.72
|
| Rate for Payer: Zelis Auto |
$841.60
|
| Rate for Payer: Zelis Worker's Compensation |
$574.39
|
|
|
REMOVE EAR LESION
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 69540
|
| Hospital Charge Code |
6169540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
REMOVE EAR LESION
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 69550
|
| Hospital Charge Code |
6169550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.39 |
| 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 |
$1,262.40
|
| 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 |
$1,262.40
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$1,788.40
|
| Rate for Payer: First Health Commercial |
$1,893.60
|
| Rate for Payer: First Health Workers Compensation |
$812.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,893.60
|
| Rate for Payer: GEHA Commercial |
$1,683.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,893.60
|
| 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 |
$1,914.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,472.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,893.60
|
| 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 |
$1,998.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,578.00
|
| 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 |
$1,956.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$841.60
|
| 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 |
$574.39
|
|
|
REMOVE EAR LESION
|
Facility
|
OP
|
$3,186.00
|
|
|
Service Code
|
CPT 69552
|
| Hospital Charge Code |
6169552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$869.78 |
| 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 |
$1,911.60
|
| 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 |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cigna Commercial |
$2,708.10
|
| Rate for Payer: First Health Commercial |
$2,867.40
|
| Rate for Payer: First Health Workers Compensation |
$1,230.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,867.40
|
| Rate for Payer: GEHA Commercial |
$2,548.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,867.40
|
| 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 |
$2,899.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,230.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,867.40
|
| 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 |
$3,026.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,389.50
|
| 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 |
$2,962.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,274.40
|
| 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 |
$869.78
|
|
|
REMOVE ELBOW BONE LESION
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT 24138
|
| Hospital Charge Code |
6124138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.74 |
| 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 |
$821.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: First Health Workers Compensation |
$528.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$1,095.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| 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 |
$1,245.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| 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 |
$1,273.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$547.60
|
| 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 |
$373.74
|
|
|
REMOVE ELBOW BONE LESION
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT 24138
|
| Hospital Charge Code |
6124138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.74 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: First Health Workers Compensation |
$528.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$958.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Worker's Compensation |
$373.74
|
|
|
REMOVE ELBOW JOINT IMPLANT
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
CPT 24160
|
| Hospital Charge Code |
6124160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.71 |
| 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 |
$1,564.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$2,085.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| 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 |
$2,372.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| 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 |
$2,476.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| 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 |
$2,424.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| 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 |
$711.71
|
|
|
REMOVE ELBOW JOINT IMPLANT
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
CPT 24160
|
| Hospital Charge Code |
6124160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.71 |
| Max. Negotiated Rate |
$2,476.65 |
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$1,824.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| Rate for Payer: Multiplan All |
$2,372.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,476.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,424.51
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| Rate for Payer: Zelis Worker's Compensation |
$711.71
|
|
|
REMOVE ELBOW JOINT LINING
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 24102
|
| Hospital Charge Code |
6124102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.43 |
| Max. Negotiated Rate |
$1,195.10 |
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$1,069.30
|
| Rate for Payer: First Health Commercial |
$1,132.20
|
| Rate for Payer: First Health Workers Compensation |
$485.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,132.20
|
| Rate for Payer: GEHA Commercial |
$880.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,132.20
|
| Rate for Payer: Multiplan All |
$1,144.78
|
| Rate for Payer: OMNI Networks Commercial |
$880.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,132.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,195.10
|
| Rate for Payer: Three Rivers Provider Network All |
$943.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,169.94
|
| Rate for Payer: Zelis Auto |
$503.20
|
| Rate for Payer: Zelis Worker's Compensation |
$343.43
|
|
|
REMOVE ELBOW JOINT LINING
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 24102
|
| Hospital Charge Code |
6124102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.43 |
| 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 |
$754.80
|
| 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 |
$754.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$1,069.30
|
| Rate for Payer: First Health Commercial |
$1,132.20
|
| Rate for Payer: First Health Workers Compensation |
$485.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,132.20
|
| Rate for Payer: GEHA Commercial |
$1,006.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,132.20
|
| 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 |
$1,144.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$880.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,132.20
|
| 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 |
$1,195.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$943.50
|
| 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 |
$1,169.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$503.20
|
| 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 |
$343.43
|
|
|
REMOVE ELBOW LESION
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
6124120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$293.75 |
| 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 |
$645.60
|
| 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 |
$645.60
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cigna Commercial |
$914.60
|
| Rate for Payer: First Health Commercial |
$968.40
|
| Rate for Payer: First Health Workers Compensation |
$415.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$968.40
|
| Rate for Payer: GEHA Commercial |
$860.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$968.40
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$979.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$753.20
|
| Rate for Payer: One Health Plan PPO/POS |
$968.40
|
| 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 |
$1,022.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$807.00
|
| 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 |
$1,000.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$430.40
|
| 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 |
$293.75
|
|
|
REMOVE ELBOW LESION
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
6124120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$293.75 |
| Max. Negotiated Rate |
$1,022.20 |
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cigna Commercial |
$914.60
|
| Rate for Payer: First Health Commercial |
$968.40
|
| Rate for Payer: First Health Workers Compensation |
$415.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$968.40
|
| Rate for Payer: GEHA Commercial |
$753.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$968.40
|
| Rate for Payer: Multiplan All |
$979.16
|
| Rate for Payer: OMNI Networks Commercial |
$753.20
|
| Rate for Payer: One Health Plan PPO/POS |
$968.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,022.20
|
| Rate for Payer: Three Rivers Provider Network All |
$807.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,000.68
|
| Rate for Payer: Zelis Auto |
$430.40
|
| Rate for Payer: Zelis Worker's Compensation |
$293.75
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 54840
|
| Hospital Charge Code |
6154840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$3,890.28 |
| 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 |
$493.80
|
| 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 |
$1,945.14
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| 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 |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| 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 |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$329.20
|
| 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 |
$224.68
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 54830
|
| Hospital Charge Code |
6154830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.44 |
| 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 |
$572.40
|
| 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 |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$810.90
|
| Rate for Payer: First Health Commercial |
$858.60
|
| Rate for Payer: First Health Workers Compensation |
$368.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$858.60
|
| Rate for Payer: GEHA Commercial |
$763.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$858.60
|
| 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 |
$868.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$667.80
|
| Rate for Payer: One Health Plan PPO/POS |
$858.60
|
| 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 |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$715.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$887.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$381.60
|
| 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 |
$260.44
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 54830
|
| Hospital Charge Code |
6154830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.44 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$810.90
|
| Rate for Payer: First Health Commercial |
$858.60
|
| Rate for Payer: First Health Workers Compensation |
$368.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$858.60
|
| Rate for Payer: GEHA Commercial |
$667.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$858.60
|
| Rate for Payer: Multiplan All |
$868.14
|
| Rate for Payer: OMNI Networks Commercial |
$667.80
|
| Rate for Payer: One Health Plan PPO/POS |
$858.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$906.30
|
| Rate for Payer: Three Rivers Provider Network All |
$715.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$887.22
|
| Rate for Payer: Zelis Auto |
$381.60
|
| Rate for Payer: Zelis Worker's Compensation |
$260.44
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 54840
|
| Hospital Charge Code |
6154840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
