|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 17271
|
| Hospital Charge Code |
6117271
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$237.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Worker's Compensation |
$92.55
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
6117286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$1,162.48 |
| 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 |
$434.40
|
| 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 |
$581.24
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cigna Commercial |
$615.40
|
| Rate for Payer: First Health Commercial |
$651.60
|
| Rate for Payer: First Health Workers Compensation |
$279.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$651.60
|
| Rate for Payer: GEHA Commercial |
$579.20
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$651.60
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$658.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$506.80
|
| Rate for Payer: One Health Plan PPO/POS |
$651.60
|
| 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 |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$687.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$543.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$673.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$289.60
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$197.65
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
6117281
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.29 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cigna Commercial |
$324.70
|
| Rate for Payer: First Health Commercial |
$343.80
|
| Rate for Payer: First Health Workers Compensation |
$147.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$343.80
|
| Rate for Payer: GEHA Commercial |
$267.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$343.80
|
| Rate for Payer: Multiplan All |
$347.62
|
| Rate for Payer: OMNI Networks Commercial |
$267.40
|
| Rate for Payer: One Health Plan PPO/POS |
$343.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$362.90
|
| Rate for Payer: Three Rivers Provider Network All |
$286.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$355.26
|
| Rate for Payer: Zelis Auto |
$152.80
|
| Rate for Payer: Zelis Worker's Compensation |
$104.29
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
6117284
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.87 |
| Max. Negotiated Rate |
$1,162.48 |
| 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 |
$322.80
|
| 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 |
$581.24
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cigna Commercial |
$457.30
|
| Rate for Payer: First Health Commercial |
$484.20
|
| Rate for Payer: First Health Workers Compensation |
$207.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$484.20
|
| Rate for Payer: GEHA Commercial |
$430.40
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$484.20
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$489.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$376.60
|
| Rate for Payer: One Health Plan PPO/POS |
$484.20
|
| 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 |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$511.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$403.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$500.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$215.20
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$146.87
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 17272
|
| Hospital Charge Code |
6117272
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
6117273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$265.80
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$376.55
|
| Rate for Payer: First Health Commercial |
$398.70
|
| Rate for Payer: First Health Workers Compensation |
$171.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$398.70
|
| Rate for Payer: GEHA Commercial |
$354.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$398.70
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$403.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$310.10
|
| Rate for Payer: One Health Plan PPO/POS |
$398.70
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$420.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$332.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$177.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$120.94
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
6117273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$376.55
|
| Rate for Payer: First Health Commercial |
$398.70
|
| Rate for Payer: First Health Workers Compensation |
$171.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$398.70
|
| Rate for Payer: GEHA Commercial |
$310.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$398.70
|
| Rate for Payer: Multiplan All |
$403.13
|
| Rate for Payer: OMNI Networks Commercial |
$310.10
|
| Rate for Payer: One Health Plan PPO/POS |
$398.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$420.85
|
| Rate for Payer: Three Rivers Provider Network All |
$332.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.99
|
| Rate for Payer: Zelis Auto |
$177.20
|
| Rate for Payer: Zelis Worker's Compensation |
$120.94
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
6117282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$419.90 |
| 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 |
$265.20
|
| 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 |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| 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 |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| 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 |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| 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 |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 54055
|
| Hospital Charge Code |
6154055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| 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 |
$168.60
|
| 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 |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$224.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| 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 |
$255.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| 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 |
$266.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| 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 |
$261.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$112.40
|
| 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 |
$76.71
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 54065
|
| Hospital Charge Code |
6154065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.42 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$370.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| Rate for Payer: Multiplan All |
$481.39
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$502.55
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.97
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 54065
|
| Hospital Charge Code |
6154065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.42 |
| 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 |
$317.40
|
| 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 |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$423.20
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| 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 |
$481.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| 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 |
$502.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| 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 |
$491.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$211.60
|
| 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 |
$144.42
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 54055
|
| Hospital Charge Code |
6154055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$196.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
1900028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.28 |
| Max. Negotiated Rate |
$672.60 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$601.80
|
| Rate for Payer: First Health Commercial |
$637.20
|
| Rate for Payer: First Health Workers Compensation |
$273.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$637.20
|
| Rate for Payer: GEHA Commercial |
$495.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$637.20
|
| Rate for Payer: Multiplan All |
$644.28
|
| Rate for Payer: OMNI Networks Commercial |
$495.60
|
| Rate for Payer: One Health Plan PPO/POS |
$637.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$672.60
|
| Rate for Payer: Three Rivers Provider Network All |
$531.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$658.44
|
| Rate for Payer: Zelis Auto |
$283.20
|
| Rate for Payer: Zelis Worker's Compensation |
$193.28
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
20300028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
21600027
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
IP
|
$456.90
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
7217004
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$124.73 |
| Max. Negotiated Rate |
$434.06 |
| Rate for Payer: Cash Price |
$274.14
|
| Rate for Payer: Cigna Commercial |
$388.37
|
| Rate for Payer: First Health Commercial |
$411.21
|
| Rate for Payer: First Health Workers Compensation |
$176.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.21
|
| Rate for Payer: GEHA Commercial |
$319.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.21
|
| Rate for Payer: Multiplan All |
$415.78
|
| Rate for Payer: OMNI Networks Commercial |
$319.83
|
| Rate for Payer: One Health Plan PPO/POS |
$411.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.06
|
| Rate for Payer: Three Rivers Provider Network All |
$342.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.92
|
| Rate for Payer: Zelis Auto |
$182.76
|
| Rate for Payer: Zelis Worker's Compensation |
$124.73
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
6117004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$83.81 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$184.20
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$260.95
|
| Rate for Payer: First Health Commercial |
$276.30
|
| Rate for Payer: First Health Workers Compensation |
$118.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$276.30
|
| Rate for Payer: GEHA Commercial |
$245.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$276.30
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$279.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$214.90
|
| Rate for Payer: One Health Plan PPO/POS |
$276.30
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$291.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$230.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$285.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$122.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$83.81
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
OP
|
$456.90
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
7217004
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$124.73 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$274.14
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$274.14
|
| Rate for Payer: Cash Price |
$274.14
|
| Rate for Payer: Cigna Commercial |
$388.37
|
| Rate for Payer: First Health Commercial |
$411.21
|
| Rate for Payer: First Health Workers Compensation |
$176.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.21
|
| Rate for Payer: GEHA Commercial |
$365.52
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.21
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$415.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$319.83
|
| Rate for Payer: One Health Plan PPO/POS |
$411.21
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$342.68
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$182.76
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$124.73
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
20300028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$273.00
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
OP
|
$456.90
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
8517004
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$124.73 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$274.14
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$274.14
|
| Rate for Payer: Cash Price |
$274.14
|
| Rate for Payer: Cigna Commercial |
$388.37
|
| Rate for Payer: First Health Commercial |
$411.21
|
| Rate for Payer: First Health Workers Compensation |
$176.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.21
|
| Rate for Payer: GEHA Commercial |
$365.52
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.21
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$415.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$319.83
|
| Rate for Payer: One Health Plan PPO/POS |
$411.21
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$342.68
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$182.76
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$124.73
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
25500027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
9400031
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
25500027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$273.00
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
IP
|
$456.90
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
8517004
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$124.73 |
| Max. Negotiated Rate |
$434.06 |
| Rate for Payer: Cash Price |
$274.14
|
| Rate for Payer: Cigna Commercial |
$388.37
|
| Rate for Payer: First Health Commercial |
$411.21
|
| Rate for Payer: First Health Workers Compensation |
$176.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.21
|
| Rate for Payer: GEHA Commercial |
$319.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.21
|
| Rate for Payer: Multiplan All |
$415.78
|
| Rate for Payer: OMNI Networks Commercial |
$319.83
|
| Rate for Payer: One Health Plan PPO/POS |
$411.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.06
|
| Rate for Payer: Three Rivers Provider Network All |
$342.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.92
|
| Rate for Payer: Zelis Auto |
$182.76
|
| Rate for Payer: Zelis Worker's Compensation |
$124.73
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
1900028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.28 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$424.80
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$601.80
|
| Rate for Payer: First Health Commercial |
$637.20
|
| Rate for Payer: First Health Workers Compensation |
$273.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$637.20
|
| Rate for Payer: GEHA Commercial |
$566.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$637.20
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$644.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$495.60
|
| Rate for Payer: One Health Plan PPO/POS |
$637.20
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$672.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$531.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$658.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$283.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$193.28
|
|
