|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
|
Facility
|
OP
|
$3,708.46
|
|
|
Service Code
|
CPT 64635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,032.26 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,303.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,303.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,032.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: First Health Workers Compensation |
$2,386.39
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,053.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,216.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,053.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,053.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$1,687.35
|
|
|
DESTRUCTION LESIONS VULVA SIMPLE
|
Facility
|
IP
|
$548.48
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
23556501
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$149.74 |
| Max. Negotiated Rate |
$521.06 |
| Rate for Payer: Cash Price |
$329.09
|
| Rate for Payer: Cigna Commercial |
$466.21
|
| Rate for Payer: First Health Commercial |
$493.63
|
| Rate for Payer: First Health Workers Compensation |
$211.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.63
|
| Rate for Payer: GEHA Commercial |
$383.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.63
|
| Rate for Payer: Multiplan All |
$499.12
|
| Rate for Payer: OMNI Networks Commercial |
$383.94
|
| Rate for Payer: One Health Plan PPO/POS |
$493.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$521.06
|
| Rate for Payer: Three Rivers Provider Network All |
$411.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$510.09
|
| Rate for Payer: Zelis Auto |
$219.39
|
| Rate for Payer: Zelis Worker's Compensation |
$149.74
|
|
|
DESTRUCTION LESIONS VULVA SIMPLE
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
6156501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$276.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
DESTRUCTION LESIONS VULVA SIMPLE
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
21600124
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$242.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
DESTRUCTION LESIONS VULVA SIMPLE
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
21600124
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$276.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
DESTRUCTION LESIONS VULVA SIMPLE
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
6156501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$242.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
DESTRUCTION LESIONS VULVA SIMPLE
|
Facility
|
OP
|
$548.48
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
23556501
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$149.74 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$329.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$329.09
|
| Rate for Payer: Cash Price |
$329.09
|
| Rate for Payer: Cigna Commercial |
$466.21
|
| Rate for Payer: First Health Commercial |
$493.63
|
| Rate for Payer: First Health Workers Compensation |
$211.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.63
|
| Rate for Payer: GEHA Commercial |
$438.78
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.63
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$499.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$383.94
|
| Rate for Payer: One Health Plan PPO/POS |
$493.63
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$521.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$411.36
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$510.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$219.39
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$149.74
|
|
|
DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2
|
Facility
|
IP
|
$568.56
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
8517282
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$540.13 |
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cigna Commercial |
$483.28
|
| Rate for Payer: First Health Commercial |
$511.70
|
| Rate for Payer: First Health Workers Compensation |
$219.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.70
|
| Rate for Payer: GEHA Commercial |
$397.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.70
|
| Rate for Payer: Multiplan All |
$517.39
|
| Rate for Payer: OMNI Networks Commercial |
$397.99
|
| Rate for Payer: One Health Plan PPO/POS |
$511.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.13
|
| Rate for Payer: Three Rivers Provider Network All |
$426.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.76
|
| Rate for Payer: Zelis Auto |
$227.42
|
| Rate for Payer: Zelis Worker's Compensation |
$155.22
|
|
|
DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2
|
Facility
|
OP
|
$568.56
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
7217282
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$540.13 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cigna Commercial |
$483.28
|
| Rate for Payer: First Health Commercial |
$511.70
|
| Rate for Payer: First Health Workers Compensation |
$219.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.70
|
| Rate for Payer: GEHA Commercial |
$454.85
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$517.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$397.99
|
| Rate for Payer: One Health Plan PPO/POS |
$511.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$426.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$227.42
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$155.22
|
|
|
DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2
|
Facility
|
OP
|
$568.56
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
8517282
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$540.13 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cigna Commercial |
$483.28
|
| Rate for Payer: First Health Commercial |
$511.70
|
| Rate for Payer: First Health Workers Compensation |
$219.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.70
|
| Rate for Payer: GEHA Commercial |
$454.85
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$517.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$397.99
|
| Rate for Payer: One Health Plan PPO/POS |
$511.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$426.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$227.42
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$155.22
|
|
|
DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2
|
Facility
|
IP
|
$568.56
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
7217282
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$540.13 |
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cigna Commercial |
$483.28
|
| Rate for Payer: First Health Commercial |
$511.70
|
| Rate for Payer: First Health Workers Compensation |
$219.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.70
|
| Rate for Payer: GEHA Commercial |
$397.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.70
|
| Rate for Payer: Multiplan All |
$517.39
|
| Rate for Payer: OMNI Networks Commercial |
$397.99
|
| Rate for Payer: One Health Plan PPO/POS |
$511.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.13
|
| Rate for Payer: Three Rivers Provider Network All |
$426.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.76
|
| Rate for Payer: Zelis Auto |
$227.42
|
| Rate for Payer: Zelis Worker's Compensation |
$155.22
|
|
|
DESTRUCTION MAL LESION T/A/L 0.6-1.0CM
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
9400033
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$296.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
DESTRUCTION MAL LESION T/A/L 0.6-1.0CM
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
6117261
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$296.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
DESTRUCTION MAL LESION T/A/L 0.6-1.0CM
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
9400033
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$338.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
DESTRUCTION MAL LESION T/A/L 0.6-1.0CM
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
6117261
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$338.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
DESTRUCTION MAL LESION T/A/L 1.1-2.0CM
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
9400034
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
DESTRUCTION MAL LESION T/A/L 1.1-2.0CM
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
9400034
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$362.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
DESTRUCTION MAL LESION T/A/L 1.1-2.0CM
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
6117262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
DESTRUCTION MAL LESION T/A/L 1.1-2.0CM
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
6117262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$362.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
DESTRUCTION MAL LESION T/A/L 2.1-3.0CM
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
9400035
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$396.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
DESTRUCTION MAL LESION T/A/L 2.1-3.0CM
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
6117263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$452.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
DESTRUCTION MAL LESION T/A/L 2.1-3.0CM
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
6117263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$396.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
DESTRUCTION MAL LESION T/A/L 2.1-3.0CM
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
9400035
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$452.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
DESTRUCTION MAL LESION T/A/L 3.1-4.0CM
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 17264
|
| Hospital Charge Code |
9400036
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$364.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$515.95
|
| Rate for Payer: First Health Commercial |
$546.30
|
| Rate for Payer: First Health Workers Compensation |
$234.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$546.30
|
| Rate for Payer: GEHA Commercial |
$485.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$546.30
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$552.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$424.90
|
| Rate for Payer: One Health Plan PPO/POS |
$546.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$576.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$455.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$564.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$242.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$165.71
|
|
|
DESTRUCTION MAL LESION T/A/L 3.1-4.0CM
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 17264
|
| Hospital Charge Code |
6117264
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$364.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$515.95
|
| Rate for Payer: First Health Commercial |
$546.30
|
| Rate for Payer: First Health Workers Compensation |
$234.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$546.30
|
| Rate for Payer: GEHA Commercial |
$485.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$546.30
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$552.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$424.90
|
| Rate for Payer: One Health Plan PPO/POS |
$546.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$576.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$455.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$564.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$242.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$165.71
|
|
