|
REMOVE THIGH PRESSURE SORE
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 15953
|
| Hospital Charge Code |
6115953
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$552.55 |
| Max. Negotiated Rate |
$1,922.80 |
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$1,720.40
|
| Rate for Payer: First Health Commercial |
$1,821.60
|
| Rate for Payer: First Health Workers Compensation |
$781.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,821.60
|
| Rate for Payer: GEHA Commercial |
$1,416.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,821.60
|
| Rate for Payer: Multiplan All |
$1,841.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,416.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,821.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,922.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,518.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,882.32
|
| Rate for Payer: Zelis Auto |
$809.60
|
| Rate for Payer: Zelis Worker's Compensation |
$552.55
|
|
|
REMOVE THORACIC LYMPH NODES
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
CPT 38746
|
| Hospital Charge Code |
6138746
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$489.60
|
| Rate for Payer: First Health Commercial |
$518.40
|
| Rate for Payer: First Health Workers Compensation |
$222.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$518.40
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$518.40
|
| Rate for Payer: Multiplan All |
$524.16
|
| Rate for Payer: OMNI Networks Commercial |
$403.20
|
| Rate for Payer: One Health Plan PPO/POS |
$518.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$547.20
|
| Rate for Payer: Three Rivers Provider Network All |
$432.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$535.68
|
| Rate for Payer: Zelis Auto |
$230.40
|
| Rate for Payer: Zelis Worker's Compensation |
$157.25
|
|
|
REMOVE THORACIC LYMPH NODES
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
CPT 38746
|
| Hospital Charge Code |
6138746
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$489.60
|
| Rate for Payer: First Health Commercial |
$518.40
|
| Rate for Payer: First Health Workers Compensation |
$222.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$518.40
|
| Rate for Payer: GEHA Commercial |
$460.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$518.40
|
| Rate for Payer: Humana ChoiceCare |
$149.76
|
| Rate for Payer: Multiplan All |
$524.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$345.60
|
| Rate for Payer: OMNI Networks Commercial |
$403.20
|
| Rate for Payer: One Health Plan PPO/POS |
$518.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$547.20
|
| Rate for Payer: Three Rivers Provider Network All |
$432.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$506.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$535.68
|
| Rate for Payer: Zelis Auto |
$230.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$288.00
|
| Rate for Payer: Zelis Worker's Compensation |
$157.25
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 60281
|
| Hospital Charge Code |
6160281
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$967.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 60281
|
| Hospital Charge Code |
6160281
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$846.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 60280
|
| Hospital Charge Code |
6160280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$545.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$350.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$727.20
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$863.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$845.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$363.60
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$248.16
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 60280
|
| Hospital Charge Code |
6160280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$863.55 |
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$350.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$636.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$863.55
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$845.37
|
| Rate for Payer: Zelis Auto |
$363.60
|
| Rate for Payer: Zelis Worker's Compensation |
$248.16
|
|
|
REMOVE THYROID LESION
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 60200
|
| Hospital Charge Code |
6160200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$819.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,929.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,905.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$1,092.80
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,984.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,601.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,984.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,984.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
REMOVE THYROID LESION
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 60200
|
| Hospital Charge Code |
6160200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$956.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
REMOVE TONSILS AND ADENOIDS
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 42820
|
| Hospital Charge Code |
6142820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$637.50
|
| Rate for Payer: First Health Commercial |
$675.00
|
| Rate for Payer: First Health Workers Compensation |
$289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.00
|
| Rate for Payer: GEHA Commercial |
$600.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$682.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$525.00
|
| Rate for Payer: One Health Plan PPO/POS |
$675.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$712.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$562.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$697.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$300.00
|
| 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 |
$204.75
|
|
|
REMOVE TONSILS AND ADENOIDS
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT 42821
|
| Hospital Charge Code |
6142821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.67 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$467.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Cigna Commercial |
$662.15
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: First Health Workers Compensation |
$300.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$701.10
|
| Rate for Payer: GEHA Commercial |
$623.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$701.10
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$708.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$545.30
|
| Rate for Payer: One Health Plan PPO/POS |
$701.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$740.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$584.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$724.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$311.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$212.67
|
|
|
REMOVE TONSILS AND ADENOIDS
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 42820
|
| Hospital Charge Code |
6142820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$637.50
|
| Rate for Payer: First Health Commercial |
$675.00
|
| Rate for Payer: First Health Workers Compensation |
$289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.00
|
| Rate for Payer: GEHA Commercial |
$525.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.00
|
| Rate for Payer: Multiplan All |
$682.50
|
| Rate for Payer: OMNI Networks Commercial |
$525.00
|
| Rate for Payer: One Health Plan PPO/POS |
$675.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$712.50
|
| Rate for Payer: Three Rivers Provider Network All |
$562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$697.50
|
| Rate for Payer: Zelis Auto |
$300.00
|
| Rate for Payer: Zelis Worker's Compensation |
$204.75
|
|
|
REMOVE TONSILS AND ADENOIDS
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT 42821
|
| Hospital Charge Code |
6142821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.67 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Cigna Commercial |
$662.15
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: First Health Workers Compensation |
$300.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$701.10
|
| Rate for Payer: GEHA Commercial |
$545.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$701.10
|
| Rate for Payer: Multiplan All |
$708.89
|
| Rate for Payer: OMNI Networks Commercial |
$545.30
|
| Rate for Payer: One Health Plan PPO/POS |
$701.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$740.05
|
| Rate for Payer: Three Rivers Provider Network All |
$584.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$724.47
|
| Rate for Payer: Zelis Auto |
$311.60
|
| Rate for Payer: Zelis Worker's Compensation |
$212.67
|
|
|
REMOVE/TRANSPLANT TENDON
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT 23440
|
| Hospital Charge Code |
6123440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$423.15 |
| Max. Negotiated Rate |
$1,472.50 |
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,317.50
|
| Rate for Payer: First Health Commercial |
$1,395.00
|
| Rate for Payer: First Health Workers Compensation |
$598.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,395.00
|
| Rate for Payer: GEHA Commercial |
$1,085.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,395.00
|
| Rate for Payer: Multiplan All |
$1,410.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,085.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,395.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,472.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,162.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,441.50
|
| Rate for Payer: Zelis Auto |
$620.00
|
| Rate for Payer: Zelis Worker's Compensation |
$423.15
|
|
|
REMOVE/TRANSPLANT TENDON
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 23440
|
| Hospital Charge Code |
6123440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$423.15 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$930.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,317.50
|
| Rate for Payer: First Health Commercial |
$1,395.00
|
| Rate for Payer: First Health Workers Compensation |
$598.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,395.00
|
| Rate for Payer: GEHA Commercial |
$1,240.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,395.00
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,410.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,085.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,395.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,472.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,162.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,441.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$620.00
|
| 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 |
$423.15
|
|
|
REMOVE/TREAT LUNG LESIONS
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
CPT 32141
|
| Hospital Charge Code |
6132141
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$881.79 |
| Max. Negotiated Rate |
$3,068.50 |
| Rate for Payer: Cash Price |
$1,938.00
|
| Rate for Payer: Cigna Commercial |
$2,745.50
|
| Rate for Payer: First Health Commercial |
$2,907.00
|
| Rate for Payer: First Health Workers Compensation |
$1,247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,907.00
|
| Rate for Payer: GEHA Commercial |
$2,261.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,907.00
|
| Rate for Payer: Multiplan All |
$2,939.30
|
| Rate for Payer: OMNI Networks Commercial |
$2,261.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,907.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,068.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,422.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,003.90
|
| Rate for Payer: Zelis Auto |
$1,292.00
|
| Rate for Payer: Zelis Worker's Compensation |
$881.79
|
|
|
REMOVE/TREAT LUNG LESIONS
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 32141
|
| Hospital Charge Code |
6132141
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$807.50 |
| Max. Negotiated Rate |
$3,068.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,938.00
|
| Rate for Payer: Cash Price |
$1,938.00
|
| Rate for Payer: Cigna Commercial |
$2,745.50
|
| Rate for Payer: First Health Commercial |
$2,907.00
|
| Rate for Payer: First Health Workers Compensation |
$1,247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,907.00
|
| Rate for Payer: GEHA Commercial |
$2,584.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,907.00
|
| Rate for Payer: Humana ChoiceCare |
$839.80
|
| Rate for Payer: Multiplan All |
$2,939.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,938.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,261.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,907.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,068.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,422.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,842.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$807.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,003.90
|
| Rate for Payer: Zelis Auto |
$1,292.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,615.00
|
| Rate for Payer: Zelis Worker's Compensation |
$881.79
|
|
|
REMOVE TUBAL OBSTRUCTION
|
Facility
|
IP
|
$1,674.00
|
|
|
Service Code
|
CPT 58760
|
| Hospital Charge Code |
6158760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$457.00 |
| Max. Negotiated Rate |
$1,590.30 |
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna Commercial |
$1,422.90
|
| Rate for Payer: First Health Commercial |
$1,506.60
|
| Rate for Payer: First Health Workers Compensation |
$646.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,506.60
|
| Rate for Payer: GEHA Commercial |
$1,171.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,506.60
|
| Rate for Payer: Multiplan All |
$1,523.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,506.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,590.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,255.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,556.82
|
| Rate for Payer: Zelis Auto |
$669.60
|
| Rate for Payer: Zelis Worker's Compensation |
$457.00
|
|
|
REMOVE TUBAL OBSTRUCTION
|
Facility
|
OP
|
$1,674.00
|
|
|
Service Code
|
CPT 58760
|
| Hospital Charge Code |
6158760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.50 |
| Max. Negotiated Rate |
$1,590.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna Commercial |
$1,422.90
|
| Rate for Payer: First Health Commercial |
$1,506.60
|
| Rate for Payer: First Health Workers Compensation |
$646.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,506.60
|
| Rate for Payer: GEHA Commercial |
$1,339.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,506.60
|
| Rate for Payer: Humana ChoiceCare |
$435.24
|
| Rate for Payer: Multiplan All |
$1,523.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,004.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,506.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,590.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,255.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,473.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,556.82
|
| Rate for Payer: Zelis Auto |
$669.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$837.00
|
| Rate for Payer: Zelis Worker's Compensation |
$457.00
|
|
|
REMOVE TUNNELED IP CATH
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
6149422
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.73 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna Commercial |
$849.15
|
| Rate for Payer: First Health Commercial |
$899.10
|
| Rate for Payer: First Health Workers Compensation |
$385.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$899.10
|
| Rate for Payer: GEHA Commercial |
$699.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$899.10
|
| Rate for Payer: Multiplan All |
$909.09
|
| Rate for Payer: OMNI Networks Commercial |
$699.30
|
| Rate for Payer: One Health Plan PPO/POS |
$899.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$949.05
|
| Rate for Payer: Three Rivers Provider Network All |
$749.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$929.07
|
| Rate for Payer: Zelis Auto |
$399.60
|
| Rate for Payer: Zelis Worker's Compensation |
$272.73
|
|
|
REMOVE TUNNELED IP CATH
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
6149422
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.73 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,363.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$599.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,363.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,872.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna Commercial |
$849.15
|
| Rate for Payer: First Health Commercial |
$899.10
|
| Rate for Payer: First Health Workers Compensation |
$385.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$899.10
|
| Rate for Payer: GEHA Commercial |
$799.20
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$899.10
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,910.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$909.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$699.30
|
| Rate for Payer: One Health Plan PPO/POS |
$899.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,205.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,910.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$949.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$749.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,910.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$929.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$399.60
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$272.73
|
|
|
REMOVE URETER CALCULUS
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT 51065
|
| Hospital Charge Code |
6151065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,129.55 |
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$1,010.65
|
| Rate for Payer: First Health Commercial |
$1,070.10
|
| Rate for Payer: First Health Workers Compensation |
$459.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,070.10
|
| Rate for Payer: GEHA Commercial |
$832.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,070.10
|
| Rate for Payer: Multiplan All |
$1,081.99
|
| Rate for Payer: OMNI Networks Commercial |
$832.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,070.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,129.55
|
| Rate for Payer: Three Rivers Provider Network All |
$891.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,105.77
|
| Rate for Payer: Zelis Auto |
$475.60
|
| Rate for Payer: Zelis Worker's Compensation |
$324.60
|
|
|
REMOVE URETER CALCULUS
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT 51065
|
| Hospital Charge Code |
6151065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$713.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$1,010.65
|
| Rate for Payer: First Health Commercial |
$1,070.10
|
| Rate for Payer: First Health Workers Compensation |
$459.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,070.10
|
| Rate for Payer: GEHA Commercial |
$951.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,070.10
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,081.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$832.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,070.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,129.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$891.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,105.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$475.60
|
| 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 |
$324.60
|
|
|
REMOVE URO SPHINCTER
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 53446
|
| Hospital Charge Code |
6153446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$509.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$360.36
|
|
|
REMOVE URO SPHINCTER
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 53446
|
| Hospital Charge Code |
6153446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,762.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,762.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,980.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$509.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$1,056.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| 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 |
$3,041.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,512.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,041.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,041.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$528.00
|
| 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 |
$360.36
|
|
