|
REMOVE MASTOID STRUCTURES
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 69505
|
| Hospital Charge Code |
6169505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$664.21 |
| 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 |
$1,459.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,459.80
|
| 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 |
$1,946.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,189.70
|
| 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 |
$2,214.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,703.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,189.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,311.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,824.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,262.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$973.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$664.21
|
|
|
REMOVE MAXILLA CYST COMPLEX
|
Facility
|
OP
|
$2,357.00
|
|
|
Service Code
|
CPT 21048
|
| Hospital Charge Code |
6121048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$643.46 |
| 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 |
$1,414.20
|
| 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 |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$2,003.45
|
| Rate for Payer: First Health Commercial |
$2,121.30
|
| Rate for Payer: First Health Workers Compensation |
$910.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,121.30
|
| Rate for Payer: GEHA Commercial |
$1,885.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,121.30
|
| 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 |
$2,144.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,649.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,121.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,239.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,767.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,192.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$942.80
|
| 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 |
$643.46
|
|
|
REMOVE MAXILLA CYST COMPLEX
|
Facility
|
IP
|
$2,357.00
|
|
|
Service Code
|
CPT 21048
|
| Hospital Charge Code |
6121048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$643.46 |
| Max. Negotiated Rate |
$2,239.15 |
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$2,003.45
|
| Rate for Payer: First Health Commercial |
$2,121.30
|
| Rate for Payer: First Health Workers Compensation |
$910.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,121.30
|
| Rate for Payer: GEHA Commercial |
$1,649.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,121.30
|
| Rate for Payer: Multiplan All |
$2,144.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,649.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,121.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,239.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,767.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,192.01
|
| Rate for Payer: Zelis Auto |
$942.80
|
| Rate for Payer: Zelis Worker's Compensation |
$643.46
|
|
|
REMOVE MESH FROM ABD WALL
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
6111008
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$619.65
|
| Rate for Payer: First Health Commercial |
$656.10
|
| Rate for Payer: First Health Workers Compensation |
$281.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$656.10
|
| Rate for Payer: GEHA Commercial |
$583.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$656.10
|
| Rate for Payer: Humana ChoiceCare |
$189.54
|
| Rate for Payer: Multiplan All |
$663.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$437.40
|
| Rate for Payer: OMNI Networks Commercial |
$510.30
|
| Rate for Payer: One Health Plan PPO/POS |
$656.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$692.55
|
| Rate for Payer: Three Rivers Provider Network All |
$546.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$641.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$182.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.97
|
| Rate for Payer: Zelis Auto |
$291.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$364.50
|
| Rate for Payer: Zelis Worker's Compensation |
$199.02
|
|
|
REMOVE MESH FROM ABD WALL
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
6111008
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$619.65
|
| Rate for Payer: First Health Commercial |
$656.10
|
| Rate for Payer: First Health Workers Compensation |
$281.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$656.10
|
| Rate for Payer: GEHA Commercial |
$510.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$656.10
|
| Rate for Payer: Multiplan All |
$663.39
|
| Rate for Payer: OMNI Networks Commercial |
$510.30
|
| Rate for Payer: One Health Plan PPO/POS |
$656.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$692.55
|
| Rate for Payer: Three Rivers Provider Network All |
$546.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.97
|
| Rate for Payer: Zelis Auto |
$291.60
|
| Rate for Payer: Zelis Worker's Compensation |
$199.02
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
CPT 54406
|
| Hospital Charge Code |
6154406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.59 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,501.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$902.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,501.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,773.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: First Health Commercial |
$1,353.60
|
| Rate for Payer: First Health Workers Compensation |
$580.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,353.60
|
| Rate for Payer: GEHA Commercial |
$1,203.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,353.60
|
| 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 |
$2,830.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,368.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,353.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,268.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,830.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,428.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,830.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,398.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$601.60
|
| 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 |
$410.59
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
CPT 54406
|
| Hospital Charge Code |
6154406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.59 |
| Max. Negotiated Rate |
$1,428.80 |
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: First Health Commercial |
$1,353.60
|
| Rate for Payer: First Health Workers Compensation |
$580.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,353.60
|
| Rate for Payer: GEHA Commercial |
$1,052.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,353.60
|
| Rate for Payer: Multiplan All |
$1,368.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,353.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,428.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,398.72
|
| Rate for Payer: Zelis Auto |
$601.60
|
| Rate for Payer: Zelis Worker's Compensation |
$410.59
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 30320
|
| Hospital Charge Code |
6130320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.42 |
| 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 |
$532.80
|
| 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 |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: First Health Workers Compensation |
$342.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$710.40
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| 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 |
$808.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| 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 |
$843.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| 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 |
$825.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$355.20
|
| 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 |
$242.42
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 30320
|
| Hospital Charge Code |
6130320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.42 |
| Max. Negotiated Rate |
$843.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: First Health Workers Compensation |
$342.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Worker's Compensation |
$242.42
|
|
|
REMOVE NEPH TUBE
|
Facility
|
OP
|
$1,855.00
|
|
| Hospital Charge Code |
2407180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$463.75 |
| Max. Negotiated Rate |
$1,762.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,113.00
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$1,576.75
|
| Rate for Payer: First Health Commercial |
$1,669.50
|
| Rate for Payer: First Health Workers Compensation |
$716.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,669.50
|
| Rate for Payer: GEHA Commercial |
$1,484.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,669.50
|
| Rate for Payer: Humana ChoiceCare |
$482.30
|
| Rate for Payer: Multiplan All |
$1,688.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,113.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,298.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,669.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,762.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,391.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,632.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$463.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,725.15
|
| Rate for Payer: Zelis Auto |
$742.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$927.50
|
| Rate for Payer: Zelis Worker's Compensation |
$506.42
|
|
|
REMOVE NEPH TUBE
|
Facility
|
IP
|
$1,855.00
|
|
| Hospital Charge Code |
2407180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$506.42 |
| Max. Negotiated Rate |
$1,762.25 |
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$1,576.75
|
| Rate for Payer: First Health Commercial |
$1,669.50
|
| Rate for Payer: First Health Workers Compensation |
$716.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,669.50
|
| Rate for Payer: GEHA Commercial |
$1,298.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,669.50
|
| Rate for Payer: Multiplan All |
$1,688.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,298.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,669.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,762.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,391.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,725.15
|
| Rate for Payer: Zelis Auto |
$742.00
|
| Rate for Payer: Zelis Worker's Compensation |
$506.42
|
|
|
REMOVE NERVE LESION
|
Facility
|
IP
|
$1,501.00
|
|
|
Service Code
|
CPT 64784
|
| Hospital Charge Code |
6164784
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.77 |
| Max. Negotiated Rate |
$1,425.95 |
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$1,275.85
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: First Health Workers Compensation |
$579.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.90
|
| Rate for Payer: GEHA Commercial |
$1,050.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.90
|
| Rate for Payer: Multiplan All |
$1,365.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.93
|
| Rate for Payer: Zelis Auto |
$600.40
|
| Rate for Payer: Zelis Worker's Compensation |
$409.77
|
|
|
REMOVE NERVE LESION
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
CPT 64784
|
| Hospital Charge Code |
6164784
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.77 |
| 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 |
$900.60
|
| 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 |
$1,854.23
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$1,275.85
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: First Health Workers Compensation |
$579.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.90
|
| Rate for Payer: GEHA Commercial |
$1,200.80
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.90
|
| 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 |
$1,365.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.90
|
| 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 |
$1,425.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.75
|
| 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 |
$1,395.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$600.40
|
| 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 |
$409.77
|
|
|
REMOVE PALATE/LESION
|
Facility
|
OP
|
$2,099.00
|
|
|
Service Code
|
CPT 42120
|
| Hospital Charge Code |
6142120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$573.03 |
| 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 |
$1,259.40
|
| 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 |
$1,259.40
|
| Rate for Payer: Cash Price |
$1,259.40
|
| Rate for Payer: Cigna Commercial |
$1,784.15
|
| Rate for Payer: First Health Commercial |
$1,889.10
|
| Rate for Payer: First Health Workers Compensation |
$810.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,889.10
|
| Rate for Payer: GEHA Commercial |
$1,679.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,889.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,910.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,469.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,889.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,994.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,574.25
|
| 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 |
$1,952.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$839.60
|
| 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 |
$573.03
|
|
|
REMOVE PALATE/LESION
|
Facility
|
IP
|
$2,099.00
|
|
|
Service Code
|
CPT 42120
|
| Hospital Charge Code |
6142120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$573.03 |
| Max. Negotiated Rate |
$1,994.05 |
| Rate for Payer: Cash Price |
$1,259.40
|
| Rate for Payer: Cigna Commercial |
$1,784.15
|
| Rate for Payer: First Health Commercial |
$1,889.10
|
| Rate for Payer: First Health Workers Compensation |
$810.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,889.10
|
| Rate for Payer: GEHA Commercial |
$1,469.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,889.10
|
| Rate for Payer: Multiplan All |
$1,910.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,469.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,889.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,994.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,574.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,952.07
|
| Rate for Payer: Zelis Auto |
$839.60
|
| Rate for Payer: Zelis Worker's Compensation |
$573.03
|
|
|
REMOVE PART OF TEMPORAL BONE
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 69535
|
| Hospital Charge Code |
6169535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,377.25 |
| Max. Negotiated Rate |
$5,233.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,305.40
|
| Rate for Payer: Cash Price |
$3,305.40
|
| Rate for Payer: Cigna Commercial |
$4,682.65
|
| Rate for Payer: First Health Commercial |
$4,958.10
|
| Rate for Payer: First Health Workers Compensation |
$2,127.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,958.10
|
| Rate for Payer: GEHA Commercial |
$4,407.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,958.10
|
| Rate for Payer: Humana ChoiceCare |
$1,432.34
|
| Rate for Payer: Multiplan All |
$5,013.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,305.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,856.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,958.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,233.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,131.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,847.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,377.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,123.37
|
| Rate for Payer: Zelis Auto |
$2,203.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,754.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,503.96
|
|
|
REMOVE PART OF TEMPORAL BONE
|
Facility
|
IP
|
$5,509.00
|
|
|
Service Code
|
CPT 69535
|
| Hospital Charge Code |
6169535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,503.96 |
| Max. Negotiated Rate |
$5,233.55 |
| Rate for Payer: Cash Price |
$3,305.40
|
| Rate for Payer: Cigna Commercial |
$4,682.65
|
| Rate for Payer: First Health Commercial |
$4,958.10
|
| Rate for Payer: First Health Workers Compensation |
$2,127.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,958.10
|
| Rate for Payer: GEHA Commercial |
$3,856.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,958.10
|
| Rate for Payer: Multiplan All |
$5,013.19
|
| Rate for Payer: OMNI Networks Commercial |
$3,856.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,958.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,233.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,131.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,123.37
|
| Rate for Payer: Zelis Auto |
$2,203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,503.96
|
|
|
REMOVE PENIS & NODES
|
Facility
|
OP
|
$3,097.00
|
|
|
Service Code
|
CPT 54135
|
| Hospital Charge Code |
6154135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$774.25 |
| Max. Negotiated Rate |
$2,942.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$2,632.45
|
| Rate for Payer: First Health Commercial |
$2,787.30
|
| Rate for Payer: First Health Workers Compensation |
$1,195.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,787.30
|
| Rate for Payer: GEHA Commercial |
$2,477.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,787.30
|
| Rate for Payer: Humana ChoiceCare |
$805.22
|
| Rate for Payer: Multiplan All |
$2,818.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,858.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,167.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,787.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,942.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,322.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,725.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,880.21
|
| Rate for Payer: Zelis Auto |
$1,238.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,548.50
|
| Rate for Payer: Zelis Worker's Compensation |
$845.48
|
|
|
REMOVE PENIS & NODES
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 54130
|
| Hospital Charge Code |
6154130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$670.76 |
| Max. Negotiated Rate |
$2,334.15 |
| Rate for Payer: Cash Price |
$1,474.20
|
| Rate for Payer: Cigna Commercial |
$2,088.45
|
| Rate for Payer: First Health Commercial |
$2,211.30
|
| Rate for Payer: First Health Workers Compensation |
$948.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,211.30
|
| Rate for Payer: GEHA Commercial |
$1,719.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,211.30
|
| Rate for Payer: Multiplan All |
$2,235.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,719.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,211.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,334.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,842.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,285.01
|
| Rate for Payer: Zelis Auto |
$982.80
|
| Rate for Payer: Zelis Worker's Compensation |
$670.76
|
|
|
REMOVE PENIS & NODES
|
Facility
|
IP
|
$3,097.00
|
|
|
Service Code
|
CPT 54135
|
| Hospital Charge Code |
6154135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$845.48 |
| Max. Negotiated Rate |
$2,942.15 |
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$2,632.45
|
| Rate for Payer: First Health Commercial |
$2,787.30
|
| Rate for Payer: First Health Workers Compensation |
$1,195.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,787.30
|
| Rate for Payer: GEHA Commercial |
$2,167.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,787.30
|
| Rate for Payer: Multiplan All |
$2,818.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,167.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,787.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,942.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,322.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,880.21
|
| Rate for Payer: Zelis Auto |
$1,238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$845.48
|
|
|
REMOVE PENIS & NODES
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT 54130
|
| Hospital Charge Code |
6154130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$2,334.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,474.20
|
| Rate for Payer: Cigna Commercial |
$2,088.45
|
| Rate for Payer: First Health Commercial |
$2,211.30
|
| Rate for Payer: First Health Workers Compensation |
$948.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,211.30
|
| Rate for Payer: GEHA Commercial |
$1,965.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,211.30
|
| Rate for Payer: Humana ChoiceCare |
$638.82
|
| Rate for Payer: Multiplan All |
$2,235.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,474.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,719.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,211.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,334.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,842.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,162.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,285.01
|
| Rate for Payer: Zelis Auto |
$982.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,228.50
|
| Rate for Payer: Zelis Worker's Compensation |
$670.76
|
|
|
REMOVE PHARYNX FOREIGN BODY
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
6142809
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
REMOVE PHARYNX FOREIGN BODY
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
6142809
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$304.80
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
REMOVE PROSTATE REGROWTH
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 52630
|
| Hospital Charge Code |
6152630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.59 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$696.15
|
| Rate for Payer: First Health Commercial |
$737.10
|
| Rate for Payer: First Health Workers Compensation |
$316.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$737.10
|
| Rate for Payer: GEHA Commercial |
$655.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$737.10
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$745.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$573.30
|
| Rate for Payer: One Health Plan PPO/POS |
$737.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$778.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$614.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$761.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$327.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$223.59
|
|
|
REMOVE PROSTATE REGROWTH
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 52630
|
| Hospital Charge Code |
6152630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.59 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$696.15
|
| Rate for Payer: First Health Commercial |
$737.10
|
| Rate for Payer: First Health Workers Compensation |
$316.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$737.10
|
| Rate for Payer: GEHA Commercial |
$573.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$737.10
|
| Rate for Payer: Multiplan All |
$745.29
|
| Rate for Payer: OMNI Networks Commercial |
$573.30
|
| Rate for Payer: One Health Plan PPO/POS |
$737.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$778.05
|
| Rate for Payer: Three Rivers Provider Network All |
$614.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$761.67
|
| Rate for Payer: Zelis Auto |
$327.60
|
| Rate for Payer: Zelis Worker's Compensation |
$223.59
|
|
