|
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 |
$1,186.28 |
| 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 |
$593.14
|
| 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 |
$593.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$484.20
|
| Rate for Payer: Humana ChoiceCare |
$652.45
|
| Rate for Payer: Humana Medicare Advantage |
$593.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$996.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$593.14
|
| Rate for Payer: Multiplan All |
$489.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,008.34
|
| 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 |
$593.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$511.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,186.28
|
| Rate for Payer: Three Rivers Provider Network All |
$403.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$581.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$593.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$500.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$593.14
|
| Rate for Payer: Zelis Auto |
$215.20
|
| Rate for Payer: Zelis Medicare |
$504.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.77
|
| Rate for Payer: Zelis Worker's Compensation |
$146.87
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
6117286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$687.80 |
| 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 |
$506.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$651.60
|
| Rate for Payer: Multiplan All |
$658.84
|
| Rate for Payer: OMNI Networks Commercial |
$506.80
|
| Rate for Payer: One Health Plan PPO/POS |
$651.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$687.80
|
| Rate for Payer: Three Rivers Provider Network All |
$543.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$673.32
|
| Rate for Payer: Zelis Auto |
$289.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.65
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
CPT 17108
|
| Hospital Charge Code |
6117108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$3,544.98 |
| 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 |
$643.20
|
| 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 |
$1,772.49
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$413.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$857.60
|
| Rate for Payer: GEHA Medicare |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| 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 |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$292.66
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
6117283
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.70 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$213.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Worker's Compensation |
$150.70
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 17274
|
| Hospital Charge Code |
6117274
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$774.28 |
| 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 |
$325.20
|
| 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 |
$387.14
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$209.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: GEHA Medicare |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$147.97
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
6117106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.55 |
| Max. Negotiated Rate |
$774.28 |
| 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 |
$418.80
|
| 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 |
$387.14
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$593.30
|
| Rate for Payer: First Health Commercial |
$628.20
|
| Rate for Payer: First Health Workers Compensation |
$269.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$628.20
|
| Rate for Payer: GEHA Commercial |
$558.40
|
| Rate for Payer: GEHA Medicare |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$628.20
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$635.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| Rate for Payer: OMNI Networks Commercial |
$488.60
|
| Rate for Payer: One Health Plan PPO/POS |
$628.20
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$663.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$523.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$649.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$279.20
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$190.55
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
6117283
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.70 |
| Max. Negotiated Rate |
$774.28 |
| 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 |
$331.20
|
| 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 |
$387.14
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$213.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: GEHA Medicare |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$150.70
|
|
|
DESTRUCTION OF SKIN LESIONS
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 17270
|
| Hospital Charge Code |
6117270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$385.08 |
| 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 |
$183.00
|
| 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 |
$192.54
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| 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 |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
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 |
$3,544.98 |
| 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 |
$1,772.49
|
| 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 |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$481.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| 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 |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$502.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| 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 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 |
$3,544.98 |
| 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 |
$1,772.49
|
| 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 |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| 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 |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
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
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
6117004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$83.81 |
| Max. Negotiated Rate |
$291.65 |
| 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 |
$214.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$276.30
|
| Rate for Payer: Multiplan All |
$279.37
|
| Rate for Payer: OMNI Networks Commercial |
$214.90
|
| Rate for Payer: One Health Plan PPO/POS |
$276.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$291.65
|
| Rate for Payer: Three Rivers Provider Network All |
$230.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$285.51
|
| Rate for Payer: Zelis Auto |
$122.80
|
| Rate for Payer: Zelis Worker's Compensation |
$83.81
|
|
|
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
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
20300028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$774.28 |
| 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 |
$387.14
|
| 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 |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
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 |
$774.28 |
| 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 |
$387.14
|
| 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 |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.21
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$415.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$342.68
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$182.76
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$124.73
|
|
|
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 |
$774.28 |
| 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 |
$387.14
|
| 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 |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.21
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$415.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$342.68
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$182.76
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$124.73
|
|
|
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 |
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
|
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 |
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
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
9400031
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$774.28 |
| 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 |
$387.14
|
| 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 |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
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 |
$774.28 |
| 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 |
$387.14
|
| 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 |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$276.30
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$279.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$291.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$230.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$285.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$122.80
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$83.81
|
|
|
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 |
$774.28 |
| 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 |
$387.14
|
| 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 |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$637.20
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$644.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| 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 |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$672.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$531.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$658.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$283.20
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$193.28
|
|
