|
REMOVE SCIATIC NERVE LESION
|
Facility
|
IP
|
$2,221.00
|
|
|
Service Code
|
CPT 64786
|
| Hospital Charge Code |
6164786
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$606.33 |
| Max. Negotiated Rate |
$2,109.95 |
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$1,887.85
|
| Rate for Payer: First Health Commercial |
$1,998.90
|
| Rate for Payer: First Health Workers Compensation |
$857.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,998.90
|
| Rate for Payer: GEHA Commercial |
$1,554.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,998.90
|
| Rate for Payer: Multiplan All |
$2,021.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,554.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,998.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,109.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,665.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,065.53
|
| Rate for Payer: Zelis Auto |
$888.40
|
| Rate for Payer: Zelis Worker's Compensation |
$606.33
|
|
|
REMOVE SELF-CONTD PENIS PROS
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
6154415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$295.93 |
| 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 |
$650.40
|
| 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 |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: First Health Commercial |
$975.60
|
| Rate for Payer: First Health Workers Compensation |
$418.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$975.60
|
| Rate for Payer: GEHA Commercial |
$867.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$975.60
|
| 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 |
$986.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$758.80
|
| Rate for Payer: One Health Plan PPO/POS |
$975.60
|
| 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 |
$1,029.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$813.00
|
| 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 |
$1,008.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$433.60
|
| 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 |
$295.93
|
|
|
REMOVE SELF-CONTD PENIS PROS
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
6154415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$295.93 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: First Health Commercial |
$975.60
|
| Rate for Payer: First Health Workers Compensation |
$418.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$975.60
|
| Rate for Payer: GEHA Commercial |
$758.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$975.60
|
| Rate for Payer: Multiplan All |
$986.44
|
| Rate for Payer: OMNI Networks Commercial |
$758.80
|
| Rate for Payer: One Health Plan PPO/POS |
$975.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,029.80
|
| Rate for Payer: Three Rivers Provider Network All |
$813.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,008.12
|
| Rate for Payer: Zelis Auto |
$433.60
|
| Rate for Payer: Zelis Worker's Compensation |
$295.93
|
|
|
REMOVE SHOULDER BLADE LESION
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
CPT 23182
|
| Hospital Charge Code |
6123182
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.09 |
| 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 |
$798.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$1,130.50
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: First Health Workers Compensation |
$513.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,197.00
|
| Rate for Payer: GEHA Commercial |
$1,064.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,197.00
|
| 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 |
$1,210.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$931.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,197.00
|
| 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 |
$1,263.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$997.50
|
| 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 |
$1,236.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$532.00
|
| 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 |
$363.09
|
|
|
REMOVE SHOULDER BLADE LESION
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
CPT 23182
|
| Hospital Charge Code |
6123182
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.09 |
| Max. Negotiated Rate |
$1,263.50 |
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$1,130.50
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: First Health Workers Compensation |
$513.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,197.00
|
| Rate for Payer: GEHA Commercial |
$931.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,197.00
|
| Rate for Payer: Multiplan All |
$1,210.30
|
| Rate for Payer: OMNI Networks Commercial |
$931.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,197.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,263.50
|
| Rate for Payer: Three Rivers Provider Network All |
$997.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,236.90
|
| Rate for Payer: Zelis Auto |
$532.00
|
| Rate for Payer: Zelis Worker's Compensation |
$363.09
|
|
|
REMOVE SHOULDER BLADE LESION
|
Facility
|
OP
|
$1,154.00
|
|
|
Service Code
|
CPT 23172
|
| Hospital Charge Code |
6123172
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.04 |
| 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 |
$692.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$980.90
|
| Rate for Payer: First Health Commercial |
$1,038.60
|
| Rate for Payer: First Health Workers Compensation |
$445.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,038.60
|
| Rate for Payer: GEHA Commercial |
$923.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,038.60
|
| 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 |
$1,050.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$807.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,038.60
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,096.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$865.50
|
| 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 |
$1,073.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$461.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$315.04
|
|
|
REMOVE SHOULDER BLADE LESION
|
Facility
|
IP
|
$1,154.00
|
|
|
Service Code
|
CPT 23172
|
| Hospital Charge Code |
6123172
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.04 |
| Max. Negotiated Rate |
$1,096.30 |
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$980.90
|
| Rate for Payer: First Health Commercial |
$1,038.60
|
| Rate for Payer: First Health Workers Compensation |
$445.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,038.60
|
| Rate for Payer: GEHA Commercial |
$807.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,038.60
|
| Rate for Payer: Multiplan All |
$1,050.14
|
| Rate for Payer: OMNI Networks Commercial |
$807.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,038.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,096.30
|
| Rate for Payer: Three Rivers Provider Network All |
$865.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,073.22
|
| Rate for Payer: Zelis Auto |
$461.60
|
| Rate for Payer: Zelis Worker's Compensation |
$315.04
|
|
|
REMOVE SHOULDER BONE PART
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 23130
|
| Hospital Charge Code |
6123130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.34 |
| Max. Negotiated Rate |
$1,180.85 |
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cigna Commercial |
$1,056.55
|
| Rate for Payer: First Health Commercial |
$1,118.70
|
| Rate for Payer: First Health Workers Compensation |
$479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,118.70
|
| Rate for Payer: GEHA Commercial |
$870.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,118.70
|
| Rate for Payer: Multiplan All |
$1,131.13
|
| Rate for Payer: OMNI Networks Commercial |
$870.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,118.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,180.85
|
| Rate for Payer: Three Rivers Provider Network All |
$932.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.99
|
| Rate for Payer: Zelis Auto |
$497.20
|
| Rate for Payer: Zelis Worker's Compensation |
$339.34
|
|
|
REMOVE SHOULDER BONE PART
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 23130
|
| Hospital Charge Code |
6123130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.34 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$745.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cigna Commercial |
$1,056.55
|
| Rate for Payer: First Health Commercial |
$1,118.70
|
| Rate for Payer: First Health Workers Compensation |
$479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,118.70
|
| Rate for Payer: GEHA Commercial |
$994.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,118.70
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,131.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$870.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,118.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,180.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$932.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$497.20
|
| 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 |
$339.34
|
|
|
REMOVE SHOULDER JOINT LINING
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 23105
|
| Hospital Charge Code |
6123105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.72 |
| 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 |
$781.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$1,107.55
|
| Rate for Payer: First Health Commercial |
$1,172.70
|
| Rate for Payer: First Health Workers Compensation |
$503.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,172.70
|
| Rate for Payer: GEHA Commercial |
$1,042.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,172.70
|
| 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 |
$1,185.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$912.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,172.70
|
| 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 |
$1,237.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$977.25
|
| 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 |
$1,211.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$521.20
|
| 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 |
$355.72
|
|
|
REMOVE SHOULDER JOINT LINING
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 23105
|
| Hospital Charge Code |
6123105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.72 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$1,107.55
|
| Rate for Payer: First Health Commercial |
$1,172.70
|
| Rate for Payer: First Health Workers Compensation |
$503.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,172.70
|
| Rate for Payer: GEHA Commercial |
$912.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,172.70
|
| Rate for Payer: Multiplan All |
$1,185.73
|
| Rate for Payer: OMNI Networks Commercial |
$912.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,172.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,237.85
|
| Rate for Payer: Three Rivers Provider Network All |
$977.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,211.79
|
| Rate for Payer: Zelis Auto |
$521.20
|
| Rate for Payer: Zelis Worker's Compensation |
$355.72
|
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 64788
|
| Hospital Charge Code |
6164788
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.59 |
| 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 |
$491.40
|
| 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 |
$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 |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$737.10
|
| 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 |
$745.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| 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 |
$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 |
$778.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$614.25
|
| 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 |
$761.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$327.60
|
| 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 |
$223.59
|
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 64774
|
| Hospital Charge Code |
6164774
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.14 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: First Health Workers Compensation |
$329.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$597.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| Rate for Payer: Multiplan All |
$777.14
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.30
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.22
|
| Rate for Payer: Zelis Auto |
$341.60
|
| Rate for Payer: Zelis Worker's Compensation |
$233.14
|
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 64788
|
| Hospital Charge Code |
6164788
|
|
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
|
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 64774
|
| Hospital Charge Code |
6164774
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.14 |
| 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 |
$512.40
|
| 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 |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: First Health Workers Compensation |
$329.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$683.20
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| 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 |
$777.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| 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 |
$811.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| 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 |
$794.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$341.60
|
| 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 |
$233.14
|
|
|
REMOVE SKIN TAGS:EA + 10
|
Facility
|
IP
|
$51.81
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
8511201
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$49.22 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cigna Commercial |
$44.04
|
| Rate for Payer: First Health Commercial |
$46.63
|
| Rate for Payer: First Health Workers Compensation |
$20.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.63
|
| Rate for Payer: GEHA Commercial |
$36.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.63
|
| Rate for Payer: Multiplan All |
$47.15
|
| Rate for Payer: OMNI Networks Commercial |
$36.27
|
| Rate for Payer: One Health Plan PPO/POS |
$46.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.22
|
| Rate for Payer: Three Rivers Provider Network All |
$38.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.18
|
| Rate for Payer: Zelis Auto |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.14
|
|
|
REMOVE SKIN TAGS:EA + 10
|
Facility
|
OP
|
$51.81
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
8511201
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$88.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cigna Commercial |
$44.04
|
| Rate for Payer: First Health Commercial |
$46.63
|
| Rate for Payer: First Health Workers Compensation |
$20.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.63
|
| Rate for Payer: GEHA Commercial |
$41.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.63
|
| Rate for Payer: Humana ChoiceCare |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$47.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.09
|
| Rate for Payer: OMNI Networks Commercial |
$36.27
|
| Rate for Payer: One Health Plan PPO/POS |
$46.63
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.22
|
| Rate for Payer: Three Rivers Provider Network All |
$38.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$45.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.18
|
| Rate for Payer: Zelis Auto |
$20.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.91
|
| Rate for Payer: Zelis Worker's Compensation |
$14.14
|
|
|
REMOVE SPERM DUCT POUCH
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT 55650
|
| Hospital Charge Code |
6155650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.00 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: First Health Workers Compensation |
$571.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,184.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Humana ChoiceCare |
$384.80
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$888.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,302.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$370.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,376.40
|
| Rate for Payer: Zelis Auto |
$592.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$740.00
|
| Rate for Payer: Zelis Worker's Compensation |
$404.04
|
|
|
REMOVE SPERM DUCT POUCH
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT 55650
|
| Hospital Charge Code |
6155650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$404.04 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: First Health Workers Compensation |
$571.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,036.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,376.40
|
| Rate for Payer: Zelis Auto |
$592.00
|
| Rate for Payer: Zelis Worker's Compensation |
$404.04
|
|
|
REMOVE SPERM POUCH LESION
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
CPT 55680
|
| Hospital Charge Code |
6155680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.43 |
| 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 |
$546.00
|
| 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 |
$546.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$773.50
|
| Rate for Payer: First Health Commercial |
$819.00
|
| Rate for Payer: First Health Workers Compensation |
$351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.00
|
| Rate for Payer: GEHA Commercial |
$728.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$828.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$637.00
|
| Rate for Payer: One Health Plan PPO/POS |
$819.00
|
| 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 |
$864.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$682.50
|
| 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 |
$846.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$364.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$248.43
|
|
|
REMOVE SPERM POUCH LESION
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
CPT 55680
|
| Hospital Charge Code |
6155680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.43 |
| Max. Negotiated Rate |
$864.50 |
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$773.50
|
| Rate for Payer: First Health Commercial |
$819.00
|
| Rate for Payer: First Health Workers Compensation |
$351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.00
|
| Rate for Payer: GEHA Commercial |
$637.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.00
|
| Rate for Payer: Multiplan All |
$828.10
|
| Rate for Payer: OMNI Networks Commercial |
$637.00
|
| Rate for Payer: One Health Plan PPO/POS |
$819.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$864.50
|
| Rate for Payer: Three Rivers Provider Network All |
$682.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$846.30
|
| Rate for Payer: Zelis Auto |
$364.00
|
| Rate for Payer: Zelis Worker's Compensation |
$248.43
|
|
|
REMOVE SPINAL CANAL CATHETER
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 62355
|
| Hospital Charge Code |
6162355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,204.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$416.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,204.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,746.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$589.90
|
| Rate for Payer: First Health Commercial |
$624.60
|
| Rate for Payer: First Health Workers Compensation |
$267.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$624.60
|
| Rate for Payer: GEHA Commercial |
$555.20
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$624.60
|
| 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 |
$1,781.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$631.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$485.80
|
| Rate for Payer: One Health Plan PPO/POS |
$624.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,057.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,781.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$659.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$520.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,781.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$645.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$277.60
|
| 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 |
$189.46
|
|
|
REMOVE SPINAL CANAL CATHETER
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 62355
|
| Hospital Charge Code |
6162355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$589.90
|
| Rate for Payer: First Health Commercial |
$624.60
|
| Rate for Payer: First Health Workers Compensation |
$267.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$624.60
|
| Rate for Payer: GEHA Commercial |
$485.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$624.60
|
| Rate for Payer: Multiplan All |
$631.54
|
| Rate for Payer: OMNI Networks Commercial |
$485.80
|
| Rate for Payer: One Health Plan PPO/POS |
$624.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$659.30
|
| Rate for Payer: Three Rivers Provider Network All |
$520.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$645.42
|
| Rate for Payer: Zelis Auto |
$277.60
|
| Rate for Payer: Zelis Worker's Compensation |
$189.46
|
|
|
REMOVE SPINE ELTRD PLATE
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT 63662
|
| Hospital Charge Code |
6163662
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$478.30 |
| Max. Negotiated Rate |
$1,664.40 |
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$1,489.20
|
| Rate for Payer: First Health Commercial |
$1,576.80
|
| Rate for Payer: First Health Workers Compensation |
$676.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,576.80
|
| Rate for Payer: GEHA Commercial |
$1,226.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,576.80
|
| Rate for Payer: Multiplan All |
$1,594.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,226.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,576.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,664.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,314.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,629.36
|
| Rate for Payer: Zelis Auto |
$700.80
|
| Rate for Payer: Zelis Worker's Compensation |
$478.30
|
|
|
REMOVE SPINE ELTRD PLATE
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT 63662
|
| Hospital Charge Code |
6163662
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$478.30 |
| Max. Negotiated Rate |
$6,530.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,051.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,528.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,265.48
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$1,489.20
|
| Rate for Payer: First Health Commercial |
$1,576.80
|
| Rate for Payer: First Health Workers Compensation |
$676.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,576.80
|
| Rate for Payer: GEHA Commercial |
$1,401.60
|
| Rate for Payer: GEHA Medicare |
$3,265.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,576.80
|
| Rate for Payer: Humana ChoiceCare |
$3,592.03
|
| Rate for Payer: Humana Medicare Advantage |
$3,265.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,486.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,580.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,265.48
|
| Rate for Payer: Multiplan All |
$1,594.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,551.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,226.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,576.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,979.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,580.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,265.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,664.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,530.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,314.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,200.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,580.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,265.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,629.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,265.48
|
| Rate for Payer: Zelis Auto |
$700.80
|
| Rate for Payer: Zelis Medicare |
$2,775.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,918.58
|
| Rate for Payer: Zelis Worker's Compensation |
$478.30
|
|
