|
REMOVE INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$305.73
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
8558301
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$678.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$678.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$537.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$294.75
|
| Rate for Payer: Cash Price |
$183.44
|
| Rate for Payer: Cash Price |
$183.44
|
| Rate for Payer: Cigna Commercial |
$259.87
|
| Rate for Payer: First Health Commercial |
$275.16
|
| Rate for Payer: First Health Workers Compensation |
$118.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$275.16
|
| Rate for Payer: GEHA Commercial |
$244.58
|
| Rate for Payer: GEHA Medicare |
$294.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$275.16
|
| Rate for Payer: Humana ChoiceCare |
$324.23
|
| Rate for Payer: Humana Medicare Advantage |
$294.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$495.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$548.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$294.75
|
| Rate for Payer: Multiplan All |
$278.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$501.07
|
| Rate for Payer: OMNI Networks Commercial |
$214.01
|
| Rate for Payer: One Health Plan PPO/POS |
$275.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$633.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$548.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$294.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$290.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$589.50
|
| Rate for Payer: Three Rivers Provider Network All |
$229.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$288.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$284.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$294.75
|
| Rate for Payer: Zelis Auto |
$122.29
|
| Rate for Payer: Zelis Medicare |
$250.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$353.70
|
| Rate for Payer: Zelis Worker's Compensation |
$83.46
|
|
|
REMOVE INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$305.73
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
8558301
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$290.44 |
| Rate for Payer: GEHA Commercial |
$214.01
|
| Rate for Payer: Cash Price |
$183.44
|
| Rate for Payer: Cigna Commercial |
$259.87
|
| Rate for Payer: First Health Commercial |
$275.16
|
| Rate for Payer: First Health Workers Compensation |
$118.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$275.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$275.16
|
| Rate for Payer: Multiplan All |
$278.21
|
| Rate for Payer: OMNI Networks Commercial |
$214.01
|
| Rate for Payer: One Health Plan PPO/POS |
$275.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$290.44
|
| Rate for Payer: Three Rivers Provider Network All |
$229.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$284.33
|
| Rate for Payer: Zelis Auto |
$122.29
|
| Rate for Payer: Zelis Worker's Compensation |
$83.46
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Facility
|
OP
|
$973.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
6137197
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.63 |
| Max. Negotiated Rate |
$6,099.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,158.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$583.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,158.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,502.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,049.86
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$827.05
|
| Rate for Payer: First Health Commercial |
$875.70
|
| Rate for Payer: First Health Workers Compensation |
$375.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$875.70
|
| Rate for Payer: GEHA Commercial |
$778.40
|
| Rate for Payer: GEHA Medicare |
$3,049.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$875.70
|
| Rate for Payer: Humana ChoiceCare |
$3,354.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,049.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,123.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,553.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,049.86
|
| Rate for Payer: Multiplan All |
$885.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,184.76
|
| Rate for Payer: OMNI Networks Commercial |
$681.10
|
| Rate for Payer: One Health Plan PPO/POS |
$875.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,948.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,553.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,049.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$924.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,099.72
|
| Rate for Payer: Three Rivers Provider Network All |
$729.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,988.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,553.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,049.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$904.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,049.86
|
| Rate for Payer: Zelis Auto |
$389.20
|
| Rate for Payer: Zelis Medicare |
$2,592.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,659.83
|
| Rate for Payer: Zelis Worker's Compensation |
$265.63
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Facility
|
IP
|
$973.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
6137197
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.63 |
| Max. Negotiated Rate |
$924.35 |
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$827.05
|
| Rate for Payer: First Health Commercial |
$875.70
|
| Rate for Payer: First Health Workers Compensation |
$375.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$875.70
|
| Rate for Payer: GEHA Commercial |
$681.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$875.70
|
| Rate for Payer: Multiplan All |
$885.43
|
| Rate for Payer: OMNI Networks Commercial |
$681.10
|
| Rate for Payer: One Health Plan PPO/POS |
$875.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$924.35
|
| Rate for Payer: Three Rivers Provider Network All |
$729.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$904.89
|
| Rate for Payer: Zelis Auto |
$389.20
|
| Rate for Payer: Zelis Worker's Compensation |
$265.63
|
|
|
REMOVE JAW JOINT CARTILAGE
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 21060
|
| Hospital Charge Code |
6121060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$446.36 |
| Max. Negotiated Rate |
$1,553.25 |
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna Commercial |
$1,389.75
|
| Rate for Payer: First Health Commercial |
$1,471.50
|
| Rate for Payer: First Health Workers Compensation |
$631.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,471.50
|
| Rate for Payer: GEHA Commercial |
$1,144.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,471.50
|
| Rate for Payer: Multiplan All |
$1,487.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,144.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,471.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,553.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,226.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,520.55
|
| Rate for Payer: Zelis Auto |
$654.00
|
| Rate for Payer: Zelis Worker's Compensation |
$446.36
|
|
|
REMOVE JAW JOINT CARTILAGE
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 21060
|
| Hospital Charge Code |
6121060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$446.36 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$981.00
|
| 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 |
$5,732.16
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna Commercial |
$1,389.75
|
| Rate for Payer: First Health Commercial |
$1,471.50
|
| Rate for Payer: First Health Workers Compensation |
$631.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,471.50
|
| Rate for Payer: GEHA Commercial |
$1,308.00
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,471.50
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,487.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,144.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,471.50
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,553.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,226.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,520.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$654.00
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$446.36
|
|
|
REMOVE KIDNEY OPEN
|
Facility
|
OP
|
$2,168.00
|
|
|
Service Code
|
CPT 50220
|
| Hospital Charge Code |
6150220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$542.00 |
| Max. Negotiated Rate |
$2,059.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cigna Commercial |
$1,842.80
|
| Rate for Payer: First Health Commercial |
$1,951.20
|
| Rate for Payer: First Health Workers Compensation |
$837.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,951.20
|
| Rate for Payer: GEHA Commercial |
$1,734.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,951.20
|
| Rate for Payer: Humana ChoiceCare |
$563.68
|
| Rate for Payer: Multiplan All |
$1,972.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,300.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,517.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,951.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,059.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,626.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,907.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$542.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,016.24
|
| Rate for Payer: Zelis Auto |
$867.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,084.00
|
| Rate for Payer: Zelis Worker's Compensation |
$591.86
|
|
|
REMOVE KIDNEY OPEN
|
Facility
|
IP
|
$2,168.00
|
|
|
Service Code
|
CPT 50220
|
| Hospital Charge Code |
6150220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$591.86 |
| Max. Negotiated Rate |
$2,059.60 |
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cigna Commercial |
$1,842.80
|
| Rate for Payer: First Health Commercial |
$1,951.20
|
| Rate for Payer: First Health Workers Compensation |
$837.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,951.20
|
| Rate for Payer: GEHA Commercial |
$1,517.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,951.20
|
| Rate for Payer: Multiplan All |
$1,972.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,517.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,951.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,059.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,626.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,016.24
|
| Rate for Payer: Zelis Auto |
$867.20
|
| Rate for Payer: Zelis Worker's Compensation |
$591.86
|
|
|
REMOVE KNEE CYST
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
6127347
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.57 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$647.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$917.15
|
| Rate for Payer: First Health Commercial |
$971.10
|
| Rate for Payer: First Health Workers Compensation |
$416.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$971.10
|
| Rate for Payer: GEHA Commercial |
$863.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$971.10
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$981.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$755.30
|
| Rate for Payer: One Health Plan PPO/POS |
$971.10
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,025.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$809.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,003.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$431.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$294.57
|
|
|
REMOVE KNEE CYST
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
6127347
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.57 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$917.15
|
| Rate for Payer: First Health Commercial |
$971.10
|
| Rate for Payer: First Health Workers Compensation |
$416.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$971.10
|
| Rate for Payer: GEHA Commercial |
$755.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$971.10
|
| Rate for Payer: Multiplan All |
$981.89
|
| Rate for Payer: OMNI Networks Commercial |
$755.30
|
| Rate for Payer: One Health Plan PPO/POS |
$971.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,025.05
|
| Rate for Payer: Three Rivers Provider Network All |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,003.47
|
| Rate for Payer: Zelis Auto |
$431.60
|
| Rate for Payer: Zelis Worker's Compensation |
$294.57
|
|
|
REMOVE KNEE JOINT LINING
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 27334
|
| Hospital Charge Code |
6127334
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.38 |
| Max. Negotiated Rate |
$1,327.15 |
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$1,187.45
|
| Rate for Payer: First Health Commercial |
$1,257.30
|
| Rate for Payer: First Health Workers Compensation |
$539.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,257.30
|
| Rate for Payer: GEHA Commercial |
$977.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,257.30
|
| Rate for Payer: Multiplan All |
$1,271.27
|
| Rate for Payer: OMNI Networks Commercial |
$977.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,257.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,327.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,299.21
|
| Rate for Payer: Zelis Auto |
$558.80
|
| Rate for Payer: Zelis Worker's Compensation |
$381.38
|
|
|
REMOVE KNEE JOINT LINING
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
6127335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.97 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: First Health Commercial |
$1,407.60
|
| Rate for Payer: First Health Workers Compensation |
$603.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,407.60
|
| Rate for Payer: GEHA Commercial |
$1,094.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,407.60
|
| Rate for Payer: Multiplan All |
$1,423.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,407.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,485.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,454.52
|
| Rate for Payer: Zelis Auto |
$625.60
|
| Rate for Payer: Zelis Worker's Compensation |
$426.97
|
|
|
REMOVE KNEE JOINT LINING
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
6127335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.97 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$938.40
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: First Health Commercial |
$1,407.60
|
| Rate for Payer: First Health Workers Compensation |
$603.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,407.60
|
| Rate for Payer: GEHA Commercial |
$1,251.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,423.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,407.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,485.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,454.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$625.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$426.97
|
|
|
REMOVE KNEE JOINT LINING
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 27334
|
| Hospital Charge Code |
6127334
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.38 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$838.20
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$1,187.45
|
| Rate for Payer: First Health Commercial |
$1,257.30
|
| Rate for Payer: First Health Workers Compensation |
$539.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,257.30
|
| Rate for Payer: GEHA Commercial |
$1,117.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,257.30
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,271.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$977.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,257.30
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,327.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,299.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$558.80
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$381.38
|
|
|
REMOVE LIMB NERVE LESION
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 64782
|
| Hospital Charge Code |
6164782
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$648.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Worker's Compensation |
$252.80
|
|
|
REMOVE LIMB NERVE LESION
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 64782
|
| Hospital Charge Code |
6164782
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$3,784.40 |
| 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 |
$555.60
|
| 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 |
$1,892.20
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$740.80
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Humana ChoiceCare |
$2,081.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,178.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,892.20
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| 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 |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,892.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Medicare |
$1,608.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,270.64
|
| Rate for Payer: Zelis Worker's Compensation |
$252.80
|
|
|
REMOVE LOWER LEG BONE LESION
|
Facility
|
OP
|
$1,202.00
|
|
|
Service Code
|
CPT 27635
|
| Hospital Charge Code |
6127635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.15 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$721.20
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$721.20
|
| Rate for Payer: Cash Price |
$721.20
|
| Rate for Payer: Cigna Commercial |
$1,021.70
|
| Rate for Payer: First Health Commercial |
$1,081.80
|
| Rate for Payer: First Health Workers Compensation |
$464.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,081.80
|
| Rate for Payer: GEHA Commercial |
$961.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,081.80
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,093.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$841.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,081.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,141.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$901.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,117.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$480.80
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$328.15
|
|
|
REMOVE LOWER LEG BONE LESION
|
Facility
|
IP
|
$1,202.00
|
|
|
Service Code
|
CPT 27635
|
| Hospital Charge Code |
6127635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.15 |
| Max. Negotiated Rate |
$1,141.90 |
| Rate for Payer: Cash Price |
$721.20
|
| Rate for Payer: Cigna Commercial |
$1,021.70
|
| Rate for Payer: First Health Commercial |
$1,081.80
|
| Rate for Payer: First Health Workers Compensation |
$464.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,081.80
|
| Rate for Payer: GEHA Commercial |
$841.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,081.80
|
| Rate for Payer: Multiplan All |
$1,093.82
|
| Rate for Payer: OMNI Networks Commercial |
$841.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,081.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,141.90
|
| Rate for Payer: Three Rivers Provider Network All |
$901.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,117.86
|
| Rate for Payer: Zelis Auto |
$480.80
|
| Rate for Payer: Zelis Worker's Compensation |
$328.15
|
|
|
REMOVE LUNG FOREIGN BODY
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
CPT 32151
|
| Hospital Charge Code |
6132151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.75 |
| Max. Negotiated Rate |
$2,005.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,266.60
|
| Rate for Payer: Cash Price |
$1,266.60
|
| Rate for Payer: Cigna Commercial |
$1,794.35
|
| Rate for Payer: First Health Commercial |
$1,899.90
|
| Rate for Payer: First Health Workers Compensation |
$815.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,899.90
|
| Rate for Payer: GEHA Commercial |
$1,688.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,899.90
|
| Rate for Payer: Humana ChoiceCare |
$548.86
|
| Rate for Payer: Multiplan All |
$1,921.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,266.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,477.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,899.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,005.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,583.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,857.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$527.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,963.23
|
| Rate for Payer: Zelis Auto |
$844.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,055.50
|
| Rate for Payer: Zelis Worker's Compensation |
$576.30
|
|
|
REMOVE LUNG FOREIGN BODY
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
CPT 32151
|
| Hospital Charge Code |
6132151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.30 |
| Max. Negotiated Rate |
$2,005.45 |
| Rate for Payer: Cash Price |
$1,266.60
|
| Rate for Payer: Cigna Commercial |
$1,794.35
|
| Rate for Payer: First Health Commercial |
$1,899.90
|
| Rate for Payer: First Health Workers Compensation |
$815.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,899.90
|
| Rate for Payer: GEHA Commercial |
$1,477.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,899.90
|
| Rate for Payer: Multiplan All |
$1,921.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,477.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,899.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,005.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,583.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,963.23
|
| Rate for Payer: Zelis Auto |
$844.40
|
| Rate for Payer: Zelis Worker's Compensation |
$576.30
|
|
|
REMOVE LUNG PNEUMONECTOMY
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 32440
|
| Hospital Charge Code |
6132440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$827.50 |
| Max. Negotiated Rate |
$3,144.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,986.00
|
| Rate for Payer: Cash Price |
$1,986.00
|
| Rate for Payer: Cigna Commercial |
$2,813.50
|
| Rate for Payer: First Health Commercial |
$2,979.00
|
| Rate for Payer: First Health Workers Compensation |
$1,277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,979.00
|
| Rate for Payer: GEHA Commercial |
$2,648.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,979.00
|
| Rate for Payer: Humana ChoiceCare |
$860.60
|
| Rate for Payer: Multiplan All |
$3,012.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,986.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,317.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,979.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,144.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,482.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,912.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$827.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,078.30
|
| Rate for Payer: Zelis Auto |
$1,324.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,655.00
|
| Rate for Payer: Zelis Worker's Compensation |
$903.63
|
|
|
REMOVE LUNG PNEUMONECTOMY
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
CPT 32440
|
| Hospital Charge Code |
6132440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$903.63 |
| Max. Negotiated Rate |
$3,144.50 |
| Rate for Payer: Cash Price |
$1,986.00
|
| Rate for Payer: Cigna Commercial |
$2,813.50
|
| Rate for Payer: First Health Commercial |
$2,979.00
|
| Rate for Payer: First Health Workers Compensation |
$1,277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,979.00
|
| Rate for Payer: GEHA Commercial |
$2,317.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,979.00
|
| Rate for Payer: Multiplan All |
$3,012.10
|
| Rate for Payer: OMNI Networks Commercial |
$2,317.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,979.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,144.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,482.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,078.30
|
| Rate for Payer: Zelis Auto |
$1,324.00
|
| Rate for Payer: Zelis Worker's Compensation |
$903.63
|
|
|
REMOVE MANDIBLE CYST COMPLEX
|
Facility
|
OP
|
$2,298.00
|
|
|
Service Code
|
CPT 21046
|
| Hospital Charge Code |
6121046
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$627.35 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$1,378.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,732.16
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$1,953.30
|
| Rate for Payer: First Health Commercial |
$2,068.20
|
| Rate for Payer: First Health Workers Compensation |
$887.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,068.20
|
| Rate for Payer: GEHA Commercial |
$1,838.40
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,068.20
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$2,091.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,608.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,068.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,183.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,723.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,137.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$919.20
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$627.35
|
|
|
REMOVE MANDIBLE CYST COMPLEX
|
Facility
|
IP
|
$2,298.00
|
|
|
Service Code
|
CPT 21046
|
| Hospital Charge Code |
6121046
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$627.35 |
| Max. Negotiated Rate |
$2,183.10 |
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$1,953.30
|
| Rate for Payer: First Health Commercial |
$2,068.20
|
| Rate for Payer: First Health Workers Compensation |
$887.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,068.20
|
| Rate for Payer: GEHA Commercial |
$1,608.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,068.20
|
| Rate for Payer: Multiplan All |
$2,091.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,608.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,068.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,183.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,723.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,137.14
|
| Rate for Payer: Zelis Auto |
$919.20
|
| Rate for Payer: Zelis Worker's Compensation |
$627.35
|
|
|
REMOVE MASTOID STRUCTURES
|
Facility
|
IP
|
$2,433.00
|
|
|
Service Code
|
CPT 69505
|
| Hospital Charge Code |
6169505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$664.21 |
| Max. Negotiated Rate |
$2,311.35 |
| Rate for Payer: Cash Price |
$1,459.80
|
| Rate for Payer: Cigna Commercial |
$2,068.05
|
| Rate for Payer: First Health Commercial |
$2,189.70
|
| Rate for Payer: First Health Workers Compensation |
$939.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,189.70
|
| Rate for Payer: GEHA Commercial |
$1,703.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,189.70
|
| Rate for Payer: Multiplan All |
$2,214.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,703.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,189.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,311.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,262.69
|
| Rate for Payer: Zelis Auto |
$973.20
|
| Rate for Payer: Zelis Worker's Compensation |
$664.21
|
|
