|
RESECT ARM/ELBOW TUM 5 CM/>
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 24079
|
| Hospital Charge Code |
6124079
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$750.20 |
| Max. Negotiated Rate |
$2,610.60 |
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Cigna Commercial |
$2,335.80
|
| Rate for Payer: First Health Commercial |
$2,473.20
|
| Rate for Payer: First Health Workers Compensation |
$1,061.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,473.20
|
| Rate for Payer: GEHA Commercial |
$1,923.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,473.20
|
| Rate for Payer: Multiplan All |
$2,500.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,923.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,473.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,610.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,061.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,555.64
|
| Rate for Payer: Zelis Auto |
$1,099.20
|
| Rate for Payer: Zelis Worker's Compensation |
$750.20
|
|
|
RESECT BACK TUM < 5 CM
|
Facility
|
OP
|
$2,132.00
|
|
|
Service Code
|
CPT 21935
|
| Hospital Charge Code |
6121935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.04 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,279.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$1,812.20
|
| Rate for Payer: First Health Commercial |
$1,918.80
|
| Rate for Payer: First Health Workers Compensation |
$823.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,918.80
|
| Rate for Payer: GEHA Commercial |
$1,705.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,918.80
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,940.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,492.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,918.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,025.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,599.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,982.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$852.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$582.04
|
|
|
RESECT BACK TUM < 5 CM
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
CPT 21935
|
| Hospital Charge Code |
6121935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.04 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$1,812.20
|
| Rate for Payer: First Health Commercial |
$1,918.80
|
| Rate for Payer: First Health Workers Compensation |
$823.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,918.80
|
| Rate for Payer: GEHA Commercial |
$1,492.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,918.80
|
| Rate for Payer: Multiplan All |
$1,940.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,492.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,918.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,025.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,599.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,982.76
|
| Rate for Payer: Zelis Auto |
$852.80
|
| Rate for Payer: Zelis Worker's Compensation |
$582.04
|
|
|
RESECT BACK TUM 5 CM/>
|
Facility
|
OP
|
$2,944.00
|
|
|
Service Code
|
CPT 21936
|
| Hospital Charge Code |
6121936
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$803.71 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,766.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,766.40
|
| Rate for Payer: Cash Price |
$1,766.40
|
| Rate for Payer: Cigna Commercial |
$2,502.40
|
| Rate for Payer: First Health Commercial |
$2,649.60
|
| Rate for Payer: First Health Workers Compensation |
$1,136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,649.60
|
| Rate for Payer: GEHA Commercial |
$2,355.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,649.60
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$2,679.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,060.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,649.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,796.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,208.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,737.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$1,177.60
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$803.71
|
|
|
RESECT BACK TUM 5 CM/>
|
Facility
|
IP
|
$2,944.00
|
|
|
Service Code
|
CPT 21936
|
| Hospital Charge Code |
6121936
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$803.71 |
| Max. Negotiated Rate |
$2,796.80 |
| Rate for Payer: Cash Price |
$1,766.40
|
| Rate for Payer: Cigna Commercial |
$2,502.40
|
| Rate for Payer: First Health Commercial |
$2,649.60
|
| Rate for Payer: First Health Workers Compensation |
$1,136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,649.60
|
| Rate for Payer: GEHA Commercial |
$2,060.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,649.60
|
| Rate for Payer: Multiplan All |
$2,679.04
|
| Rate for Payer: OMNI Networks Commercial |
$2,060.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,649.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,796.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,208.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,737.92
|
| Rate for Payer: Zelis Auto |
$1,177.60
|
| Rate for Payer: Zelis Worker's Compensation |
$803.71
|
|
|
RESECT CLAVICLE TUMOR
|
Facility
|
IP
|
$3,086.00
|
|
|
Service Code
|
CPT 23200
|
| Hospital Charge Code |
6123200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$842.48 |
| Max. Negotiated Rate |
$2,931.70 |
| Rate for Payer: Cash Price |
$1,851.60
|
| Rate for Payer: Cigna Commercial |
$2,623.10
|
| Rate for Payer: First Health Commercial |
$2,777.40
|
| Rate for Payer: First Health Workers Compensation |
$1,191.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,777.40
|
| Rate for Payer: GEHA Commercial |
$2,160.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,777.40
|
| Rate for Payer: Multiplan All |
$2,808.26
|
| Rate for Payer: OMNI Networks Commercial |
$2,160.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,777.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,931.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,314.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,869.98
|
| Rate for Payer: Zelis Auto |
$1,234.40
|
| Rate for Payer: Zelis Worker's Compensation |
$842.48
|
|
|
RESECT CLAVICLE TUMOR
|
Facility
|
OP
|
$3,086.00
|
|
|
Service Code
|
CPT 23200
|
| Hospital Charge Code |
6123200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$771.50 |
| Max. Negotiated Rate |
$2,931.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,851.60
|
| Rate for Payer: Cash Price |
$1,851.60
|
| Rate for Payer: Cigna Commercial |
$2,623.10
|
| Rate for Payer: First Health Commercial |
$2,777.40
|
| Rate for Payer: First Health Workers Compensation |
$1,191.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,777.40
|
| Rate for Payer: GEHA Commercial |
$2,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,777.40
|
| Rate for Payer: Humana ChoiceCare |
$802.36
|
| Rate for Payer: Multiplan All |
$2,808.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,851.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,160.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,777.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,931.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,314.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,715.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$771.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,869.98
|
| Rate for Payer: Zelis Auto |
$1,234.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,543.00
|
| Rate for Payer: Zelis Worker's Compensation |
$842.48
|
|
|
RESECT/DEBRIDE PANCREAS
|
Facility
|
OP
|
$6,021.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
6148105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,505.25 |
| Max. Negotiated Rate |
$5,719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,612.60
|
| Rate for Payer: Cash Price |
$3,612.60
|
| Rate for Payer: Cigna Commercial |
$5,117.85
|
| Rate for Payer: First Health Commercial |
$5,418.90
|
| Rate for Payer: First Health Workers Compensation |
$2,324.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,418.90
|
| Rate for Payer: GEHA Commercial |
$4,816.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,418.90
|
| Rate for Payer: Humana ChoiceCare |
$1,565.46
|
| Rate for Payer: Multiplan All |
$5,479.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,612.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,214.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,418.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,719.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,515.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,298.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,599.53
|
| Rate for Payer: Zelis Auto |
$2,408.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,010.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,643.73
|
|
|
RESECT/DEBRIDE PANCREAS
|
Facility
|
IP
|
$6,021.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
6148105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,643.73 |
| Max. Negotiated Rate |
$5,719.95 |
| Rate for Payer: Cash Price |
$3,612.60
|
| Rate for Payer: Cigna Commercial |
$5,117.85
|
| Rate for Payer: First Health Commercial |
$5,418.90
|
| Rate for Payer: First Health Workers Compensation |
$2,324.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,418.90
|
| Rate for Payer: GEHA Commercial |
$4,214.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,418.90
|
| Rate for Payer: Multiplan All |
$5,479.11
|
| Rate for Payer: OMNI Networks Commercial |
$4,214.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,418.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,719.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,515.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,599.53
|
| Rate for Payer: Zelis Auto |
$2,408.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,643.73
|
|
|
RESECT DISTAL FINGER TUMOR
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
CPT 26262
|
| Hospital Charge Code |
6126262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.16 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$760.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$1,077.80
|
| Rate for Payer: First Health Commercial |
$1,141.20
|
| Rate for Payer: First Health Workers Compensation |
$489.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,141.20
|
| Rate for Payer: GEHA Commercial |
$1,014.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,141.20
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,153.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$887.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,141.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,204.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$951.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,179.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$507.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$346.16
|
|
|
RESECT DISTAL FINGER TUMOR
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
CPT 26262
|
| Hospital Charge Code |
6126262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.16 |
| Max. Negotiated Rate |
$1,204.60 |
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$1,077.80
|
| Rate for Payer: First Health Commercial |
$1,141.20
|
| Rate for Payer: First Health Workers Compensation |
$489.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,141.20
|
| Rate for Payer: GEHA Commercial |
$887.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,141.20
|
| Rate for Payer: Multiplan All |
$1,153.88
|
| Rate for Payer: OMNI Networks Commercial |
$887.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,141.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,204.60
|
| Rate for Payer: Three Rivers Provider Network All |
$951.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,179.24
|
| Rate for Payer: Zelis Auto |
$507.20
|
| Rate for Payer: Zelis Worker's Compensation |
$346.16
|
|
|
RESECT DISTAL HUMERUS TUMOR
|
Facility
|
OP
|
$3,226.00
|
|
|
Service Code
|
CPT 24150
|
| Hospital Charge Code |
6124150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$880.70 |
| 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 |
$1,935.60
|
| 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 |
$1,935.60
|
| Rate for Payer: Cash Price |
$1,935.60
|
| Rate for Payer: Cigna Commercial |
$2,742.10
|
| Rate for Payer: First Health Commercial |
$2,903.40
|
| Rate for Payer: First Health Workers Compensation |
$1,245.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,903.40
|
| Rate for Payer: GEHA Commercial |
$2,580.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,903.40
|
| 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 |
$2,935.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$2,258.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,903.40
|
| 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 |
$3,064.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$2,419.50
|
| 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 |
$3,000.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$1,290.40
|
| 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 |
$880.70
|
|
|
RESECT DISTAL HUMERUS TUMOR
|
Facility
|
IP
|
$3,226.00
|
|
|
Service Code
|
CPT 24150
|
| Hospital Charge Code |
6124150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$880.70 |
| Max. Negotiated Rate |
$3,064.70 |
| Rate for Payer: Cash Price |
$1,935.60
|
| Rate for Payer: Cigna Commercial |
$2,742.10
|
| Rate for Payer: First Health Commercial |
$2,903.40
|
| Rate for Payer: First Health Workers Compensation |
$1,245.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,903.40
|
| Rate for Payer: GEHA Commercial |
$2,258.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,903.40
|
| Rate for Payer: Multiplan All |
$2,935.66
|
| Rate for Payer: OMNI Networks Commercial |
$2,258.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,903.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,064.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,419.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,000.18
|
| Rate for Payer: Zelis Auto |
$1,290.40
|
| Rate for Payer: Zelis Worker's Compensation |
$880.70
|
|
|
RESECT ENLARGED TOE
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 28341
|
| Hospital Charge Code |
6128341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.18 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: First Health Commercial |
$907.20
|
| Rate for Payer: First Health Workers Compensation |
$389.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$907.20
|
| Rate for Payer: GEHA Commercial |
$705.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$907.20
|
| Rate for Payer: Multiplan All |
$917.28
|
| Rate for Payer: OMNI Networks Commercial |
$705.60
|
| Rate for Payer: One Health Plan PPO/POS |
$907.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$957.60
|
| Rate for Payer: Three Rivers Provider Network All |
$756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$937.44
|
| Rate for Payer: Zelis Auto |
$403.20
|
| Rate for Payer: Zelis Worker's Compensation |
$275.18
|
|
|
RESECT ENLARGED TOE
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 28341
|
| Hospital Charge Code |
6128341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.18 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$604.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: First Health Commercial |
$907.20
|
| Rate for Payer: First Health Workers Compensation |
$389.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$907.20
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$907.20
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$917.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$705.60
|
| Rate for Payer: One Health Plan PPO/POS |
$907.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$937.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$403.20
|
| 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 |
$275.18
|
|
|
RESECT ENLARGED TOE TISSUE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 28340
|
| Hospital Charge Code |
6128340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$506.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$717.40
|
| Rate for Payer: First Health Commercial |
$759.60
|
| Rate for Payer: First Health Workers Compensation |
$325.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$759.60
|
| Rate for Payer: GEHA Commercial |
$675.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$759.60
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$768.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$590.80
|
| Rate for Payer: One Health Plan PPO/POS |
$759.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$801.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$633.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$784.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$337.60
|
| 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 |
$230.41
|
|
|
RESECT ENLARGED TOE TISSUE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 28340
|
| Hospital Charge Code |
6128340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$717.40
|
| Rate for Payer: First Health Commercial |
$759.60
|
| Rate for Payer: First Health Workers Compensation |
$325.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$759.60
|
| Rate for Payer: GEHA Commercial |
$590.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$759.60
|
| Rate for Payer: Multiplan All |
$768.04
|
| Rate for Payer: OMNI Networks Commercial |
$590.80
|
| Rate for Payer: One Health Plan PPO/POS |
$759.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$801.80
|
| Rate for Payer: Three Rivers Provider Network All |
$633.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$784.92
|
| Rate for Payer: Zelis Auto |
$337.60
|
| Rate for Payer: Zelis Worker's Compensation |
$230.41
|
|
|
RESECT/EXCISE LESION SKULL
|
Facility
|
OP
|
$7,090.00
|
|
|
Service Code
|
CPT 61616
|
| Hospital Charge Code |
6161616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,772.50 |
| Max. Negotiated Rate |
$6,735.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,254.00
|
| Rate for Payer: Cash Price |
$4,254.00
|
| Rate for Payer: Cigna Commercial |
$6,026.50
|
| Rate for Payer: First Health Commercial |
$6,381.00
|
| Rate for Payer: First Health Workers Compensation |
$2,737.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,381.00
|
| Rate for Payer: GEHA Commercial |
$5,672.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,381.00
|
| Rate for Payer: Humana ChoiceCare |
$1,843.40
|
| Rate for Payer: Multiplan All |
$6,451.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,254.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,963.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,381.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,735.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,317.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,239.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,772.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,593.70
|
| Rate for Payer: Zelis Auto |
$2,836.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,545.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,935.57
|
|
|
RESECT/EXCISE LESION SKULL
|
Facility
|
IP
|
$7,090.00
|
|
|
Service Code
|
CPT 61616
|
| Hospital Charge Code |
6161616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,935.57 |
| Max. Negotiated Rate |
$6,735.50 |
| Rate for Payer: Cash Price |
$4,254.00
|
| Rate for Payer: Cigna Commercial |
$6,026.50
|
| Rate for Payer: First Health Commercial |
$6,381.00
|
| Rate for Payer: First Health Workers Compensation |
$2,737.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,381.00
|
| Rate for Payer: GEHA Commercial |
$4,963.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,381.00
|
| Rate for Payer: Multiplan All |
$6,451.90
|
| Rate for Payer: OMNI Networks Commercial |
$4,963.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,381.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,735.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,317.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,593.70
|
| Rate for Payer: Zelis Auto |
$2,836.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,935.57
|
|
|
RESECT/EXCISE LESION SKULL
|
Facility
|
OP
|
$4,718.00
|
|
|
Service Code
|
CPT 61615
|
| Hospital Charge Code |
6161615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,179.50 |
| Max. Negotiated Rate |
$4,482.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,830.80
|
| Rate for Payer: Cash Price |
$2,830.80
|
| Rate for Payer: Cigna Commercial |
$4,010.30
|
| Rate for Payer: First Health Commercial |
$4,246.20
|
| Rate for Payer: First Health Workers Compensation |
$1,821.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,246.20
|
| Rate for Payer: GEHA Commercial |
$3,774.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,246.20
|
| Rate for Payer: Humana ChoiceCare |
$1,226.68
|
| Rate for Payer: Multiplan All |
$4,293.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,830.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,302.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,246.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,482.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,538.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,151.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,179.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,387.74
|
| Rate for Payer: Zelis Auto |
$1,887.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,359.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,288.01
|
|
|
RESECT/EXCISE LESION SKULL
|
Facility
|
IP
|
$4,718.00
|
|
|
Service Code
|
CPT 61615
|
| Hospital Charge Code |
6161615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,288.01 |
| Max. Negotiated Rate |
$4,482.10 |
| Rate for Payer: Cash Price |
$2,830.80
|
| Rate for Payer: Cigna Commercial |
$4,010.30
|
| Rate for Payer: First Health Commercial |
$4,246.20
|
| Rate for Payer: First Health Workers Compensation |
$1,821.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,246.20
|
| Rate for Payer: GEHA Commercial |
$3,302.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,246.20
|
| Rate for Payer: Multiplan All |
$4,293.38
|
| Rate for Payer: OMNI Networks Commercial |
$3,302.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,246.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,482.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,538.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,387.74
|
| Rate for Payer: Zelis Auto |
$1,887.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,288.01
|
|
|
RESECT FACE TUM < 2 CM
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 21015
|
| Hospital Charge Code |
6121015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$397.49 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$1,237.60
|
| Rate for Payer: First Health Commercial |
$1,310.40
|
| Rate for Payer: First Health Workers Compensation |
$562.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,310.40
|
| Rate for Payer: GEHA Commercial |
$1,019.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,310.40
|
| Rate for Payer: Multiplan All |
$1,324.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,019.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,310.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,383.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,092.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,354.08
|
| Rate for Payer: Zelis Auto |
$582.40
|
| Rate for Payer: Zelis Worker's Compensation |
$397.49
|
|
|
RESECT FACE TUM < 2 CM
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 21015
|
| Hospital Charge Code |
6121015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$397.49 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$873.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$1,237.60
|
| Rate for Payer: First Health Commercial |
$1,310.40
|
| Rate for Payer: First Health Workers Compensation |
$562.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,310.40
|
| Rate for Payer: GEHA Commercial |
$1,164.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,310.40
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,324.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,019.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,310.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,383.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,092.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,354.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$582.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$397.49
|
|
|
RESECT FACE TUM 2 CM/>
|
Facility
|
IP
|
$2,109.00
|
|
|
Service Code
|
CPT 21016
|
| Hospital Charge Code |
6121016
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$575.76 |
| Max. Negotiated Rate |
$2,003.55 |
| Rate for Payer: Cash Price |
$1,265.40
|
| Rate for Payer: Cigna Commercial |
$1,792.65
|
| Rate for Payer: First Health Commercial |
$1,898.10
|
| Rate for Payer: First Health Workers Compensation |
$814.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,898.10
|
| Rate for Payer: GEHA Commercial |
$1,476.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,898.10
|
| Rate for Payer: Multiplan All |
$1,919.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,476.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,898.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,003.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,581.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,961.37
|
| Rate for Payer: Zelis Auto |
$843.60
|
| Rate for Payer: Zelis Worker's Compensation |
$575.76
|
|
|
RESECT FACE TUM 2 CM/>
|
Facility
|
OP
|
$2,109.00
|
|
|
Service Code
|
CPT 21016
|
| Hospital Charge Code |
6121016
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$575.76 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,265.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,265.40
|
| Rate for Payer: Cash Price |
$1,265.40
|
| Rate for Payer: Cigna Commercial |
$1,792.65
|
| Rate for Payer: First Health Commercial |
$1,898.10
|
| Rate for Payer: First Health Workers Compensation |
$814.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,898.10
|
| Rate for Payer: GEHA Commercial |
$1,687.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,898.10
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,919.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,476.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,898.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,003.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,581.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,961.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$843.60
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$575.76
|
|
