|
REMOVE VAD DIFFERENT SESSION
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
6133992
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$444.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Humana ChoiceCare |
$144.30
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$333.00
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$488.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.50
|
| Rate for Payer: Zelis Worker's Compensation |
$151.51
|
|
|
REMOVE VAD DIFFERENT SESSION
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
6133992
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.51 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$388.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$151.51
|
|
|
REMOVE VAGINA GLAND LESION
|
Facility
|
OP
|
$887.16
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
6156740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.19 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$532.30
|
| Rate for Payer: Cash Price |
$532.30
|
| Rate for Payer: Cigna Commercial |
$754.09
|
| Rate for Payer: First Health Commercial |
$798.44
|
| Rate for Payer: First Health Workers Compensation |
$342.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.44
|
| Rate for Payer: GEHA Commercial |
$709.73
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.44
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$807.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$621.01
|
| Rate for Payer: One Health Plan PPO/POS |
$798.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$665.37
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$354.86
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$242.19
|
|
|
REMOVE VAGINA GLAND LESION
|
Facility
|
IP
|
$887.16
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
6156740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.19 |
| Max. Negotiated Rate |
$842.80 |
| Rate for Payer: Cash Price |
$532.30
|
| Rate for Payer: Cigna Commercial |
$754.09
|
| Rate for Payer: First Health Commercial |
$798.44
|
| Rate for Payer: First Health Workers Compensation |
$342.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.44
|
| Rate for Payer: GEHA Commercial |
$621.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.44
|
| Rate for Payer: Multiplan All |
$807.32
|
| Rate for Payer: OMNI Networks Commercial |
$621.01
|
| Rate for Payer: One Health Plan PPO/POS |
$798.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.80
|
| Rate for Payer: Three Rivers Provider Network All |
$665.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.06
|
| Rate for Payer: Zelis Auto |
$354.86
|
| Rate for Payer: Zelis Worker's Compensation |
$242.19
|
|
|
REMOVE VAGINA LESION
|
Facility
|
IP
|
$689.94
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
6157135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.35 |
| Max. Negotiated Rate |
$655.44 |
| Rate for Payer: Cash Price |
$413.96
|
| Rate for Payer: Cigna Commercial |
$586.45
|
| Rate for Payer: First Health Commercial |
$620.95
|
| Rate for Payer: First Health Workers Compensation |
$266.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.95
|
| Rate for Payer: GEHA Commercial |
$482.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.95
|
| Rate for Payer: Multiplan All |
$627.85
|
| Rate for Payer: OMNI Networks Commercial |
$482.96
|
| Rate for Payer: One Health Plan PPO/POS |
$620.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.44
|
| Rate for Payer: Three Rivers Provider Network All |
$517.46
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.64
|
| Rate for Payer: Zelis Auto |
$275.98
|
| Rate for Payer: Zelis Worker's Compensation |
$188.35
|
|
|
REMOVE VAGINA LESION
|
Facility
|
OP
|
$689.94
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
6157135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.35 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$413.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$413.96
|
| Rate for Payer: Cash Price |
$413.96
|
| Rate for Payer: Cigna Commercial |
$586.45
|
| Rate for Payer: First Health Commercial |
$620.95
|
| Rate for Payer: First Health Workers Compensation |
$266.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.95
|
| Rate for Payer: GEHA Commercial |
$551.95
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.95
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$627.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$482.96
|
| Rate for Payer: One Health Plan PPO/POS |
$620.95
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$517.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$275.98
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$188.35
|
|
|
REMOVE VAGINA LESION
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
6157130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$288.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$384.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$437.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$447.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$131.31
|
|
|
REMOVE VAGINA LESION
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
6157130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$456.95 |
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$336.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| Rate for Payer: Multiplan All |
$437.71
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$447.33
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Worker's Compensation |
$131.31
|
|
|
REMOVE VAGINA TISSUE COMPL
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
CPT 57111
|
| Hospital Charge Code |
6157111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$898.17 |
| Max. Negotiated Rate |
$3,125.50 |
| Rate for Payer: Cash Price |
$1,974.00
|
| Rate for Payer: Cigna Commercial |
$2,796.50
|
| Rate for Payer: First Health Commercial |
$2,961.00
|
| Rate for Payer: First Health Workers Compensation |
$1,270.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,961.00
|
| Rate for Payer: GEHA Commercial |
$2,303.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,961.00
|
| Rate for Payer: Multiplan All |
$2,993.90
|
| Rate for Payer: OMNI Networks Commercial |
$2,303.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,961.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,125.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,467.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,059.70
|
| Rate for Payer: Zelis Auto |
$1,316.00
|
| Rate for Payer: Zelis Worker's Compensation |
$898.17
|
|
|
REMOVE VAGINA TISSUE COMPL
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
CPT 57111
|
| Hospital Charge Code |
6157111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.50 |
| Max. Negotiated Rate |
$3,125.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,974.00
|
| Rate for Payer: Cash Price |
$1,974.00
|
| Rate for Payer: Cigna Commercial |
$2,796.50
|
| Rate for Payer: First Health Commercial |
$2,961.00
|
| Rate for Payer: First Health Workers Compensation |
$1,270.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,961.00
|
| Rate for Payer: GEHA Commercial |
$2,632.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,961.00
|
| Rate for Payer: Humana ChoiceCare |
$855.40
|
| Rate for Payer: Multiplan All |
$2,993.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,974.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,303.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,961.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,125.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,467.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,895.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$822.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,059.70
|
| Rate for Payer: Zelis Auto |
$1,316.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,645.00
|
| Rate for Payer: Zelis Worker's Compensation |
$898.17
|
|
|
REMOVE VAGINA TISSUE PART
|
Facility
|
OP
|
$3,006.00
|
|
|
Service Code
|
CPT 57107
|
| Hospital Charge Code |
6157107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$820.64 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,803.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cigna Commercial |
$2,555.10
|
| Rate for Payer: First Health Commercial |
$2,705.40
|
| Rate for Payer: First Health Workers Compensation |
$1,160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,705.40
|
| Rate for Payer: GEHA Commercial |
$2,404.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,705.40
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$2,735.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,104.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,705.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,855.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,254.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,795.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$1,202.40
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$820.64
|
|
|
REMOVE VAGINA TISSUE PART
|
Facility
|
IP
|
$3,006.00
|
|
|
Service Code
|
CPT 57107
|
| Hospital Charge Code |
6157107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$820.64 |
| Max. Negotiated Rate |
$2,855.70 |
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cigna Commercial |
$2,555.10
|
| Rate for Payer: First Health Commercial |
$2,705.40
|
| Rate for Payer: First Health Workers Compensation |
$1,160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,705.40
|
| Rate for Payer: GEHA Commercial |
$2,104.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,705.40
|
| Rate for Payer: Multiplan All |
$2,735.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,104.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,705.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,855.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,254.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,795.58
|
| Rate for Payer: Zelis Auto |
$1,202.40
|
| Rate for Payer: Zelis Worker's Compensation |
$820.64
|
|
|
REMOVE VAGINA WALL COMPLETE
|
Facility
|
OP
|
$1,816.00
|
|
|
Service Code
|
CPT 57110
|
| Hospital Charge Code |
6157110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$1,725.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$1,543.60
|
| Rate for Payer: First Health Commercial |
$1,634.40
|
| Rate for Payer: First Health Workers Compensation |
$701.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,634.40
|
| Rate for Payer: GEHA Commercial |
$1,452.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,634.40
|
| Rate for Payer: Humana ChoiceCare |
$472.16
|
| Rate for Payer: Multiplan All |
$1,652.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,089.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,271.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,634.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,725.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,362.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,598.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,688.88
|
| Rate for Payer: Zelis Auto |
$726.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$908.00
|
| Rate for Payer: Zelis Worker's Compensation |
$495.77
|
|
|
REMOVE VAGINA WALL COMPLETE
|
Facility
|
IP
|
$1,816.00
|
|
|
Service Code
|
CPT 57110
|
| Hospital Charge Code |
6157110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$495.77 |
| Max. Negotiated Rate |
$1,725.20 |
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$1,543.60
|
| Rate for Payer: First Health Commercial |
$1,634.40
|
| Rate for Payer: First Health Workers Compensation |
$701.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,634.40
|
| Rate for Payer: GEHA Commercial |
$1,271.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,634.40
|
| Rate for Payer: Multiplan All |
$1,652.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,271.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,634.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,725.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,362.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,688.88
|
| Rate for Payer: Zelis Auto |
$726.40
|
| Rate for Payer: Zelis Worker's Compensation |
$495.77
|
|
|
REMOVE VAGINA WALL PARTIAL
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 57106
|
| Hospital Charge Code |
6157106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$706.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Worker's Compensation |
$275.46
|
|
|
REMOVE VAGINA WALL PARTIAL
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 57106
|
| Hospital Charge Code |
6157106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$605.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$275.46
|
|
|
REMOVE VAGUS N ELTRD
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 64570
|
| Hospital Charge Code |
6164570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$12,161.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,768.81
|
| 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 |
$3,768.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,985.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,080.92
|
| 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 |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Humana ChoiceCare |
$6,689.01
|
| Rate for Payer: Humana Medicare Advantage |
$6,080.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,215.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,080.92
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| 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 |
$3,517.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,080.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,959.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,080.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Medicare |
$5,168.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,297.10
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
REMOVE VAGUS N ELTRD
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 64570
|
| Hospital Charge Code |
6164570
|
|
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 VC LESION SCOPE/GRAFT
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 31546
|
| Hospital Charge Code |
6131546
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.31 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$693.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
REMOVE VC LESION SCOPE/GRAFT
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 31546
|
| Hospital Charge Code |
6131546
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.31 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$808.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
REMOVE VC LESION W/SCOPE
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 31545
|
| Hospital Charge Code |
6131545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$568.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$757.60
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$378.80
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$258.53
|
|
|
REMOVE VC LESION W/SCOPE
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 31545
|
| Hospital Charge Code |
6131545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$899.65 |
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$662.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: Zelis Auto |
$378.80
|
| Rate for Payer: Zelis Worker's Compensation |
$258.53
|
|
|
REMOVE VERT BODY DCMPRN THRC
|
Facility
|
OP
|
$4,052.00
|
|
|
Service Code
|
CPT 63085
|
| Hospital Charge Code |
6163085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,013.00 |
| Max. Negotiated Rate |
$3,849.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,431.20
|
| Rate for Payer: Cash Price |
$2,431.20
|
| Rate for Payer: Cigna Commercial |
$3,444.20
|
| Rate for Payer: First Health Commercial |
$3,646.80
|
| Rate for Payer: First Health Workers Compensation |
$1,564.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,646.80
|
| Rate for Payer: GEHA Commercial |
$3,241.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,646.80
|
| Rate for Payer: Humana ChoiceCare |
$1,053.52
|
| Rate for Payer: Multiplan All |
$3,687.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,431.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,836.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,646.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,849.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,039.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,565.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,013.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,768.36
|
| Rate for Payer: Zelis Auto |
$1,620.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,026.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,106.20
|
|
|
REMOVE VERT BODY DCMPRN THRC
|
Facility
|
IP
|
$4,052.00
|
|
|
Service Code
|
CPT 63085
|
| Hospital Charge Code |
6163085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,106.20 |
| Max. Negotiated Rate |
$3,849.40 |
| Rate for Payer: Cash Price |
$2,431.20
|
| Rate for Payer: Cigna Commercial |
$3,444.20
|
| Rate for Payer: First Health Commercial |
$3,646.80
|
| Rate for Payer: First Health Workers Compensation |
$1,564.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,646.80
|
| Rate for Payer: GEHA Commercial |
$2,836.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,646.80
|
| Rate for Payer: Multiplan All |
$3,687.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,836.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,646.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,849.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,039.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,768.36
|
| Rate for Payer: Zelis Auto |
$1,620.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,106.20
|
|
|
REMOVE VERTEBRAL BODY ADD-ON
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 63086
|
| Hospital Charge Code |
6163086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$428.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$581.40
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: Zelis Auto |
$244.80
|
| Rate for Payer: Zelis Worker's Compensation |
$167.08
|
|
