|
EXCISE FOOT TENDON SHEATH
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 28088
|
| Hospital Charge Code |
6128088
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.29 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$431.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$277.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$575.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$196.29
|
|
|
EXCISE FOOT TENDON SHEATH
|
Facility
|
OP
|
$1,490.22
|
|
|
Service Code
|
CPT 28086
|
| Hospital Charge Code |
6128086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.83 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$894.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$894.13
|
| Rate for Payer: Cash Price |
$894.13
|
| Rate for Payer: Cigna Commercial |
$1,266.69
|
| Rate for Payer: First Health Commercial |
$1,341.20
|
| Rate for Payer: First Health Workers Compensation |
$575.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,341.20
|
| Rate for Payer: GEHA Commercial |
$1,192.18
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,341.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,356.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,043.15
|
| Rate for Payer: One Health Plan PPO/POS |
$1,341.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,415.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,117.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,385.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$596.09
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$406.83
|
|
|
EXCISE ILEOANAL RESERVIOR
|
Facility
|
IP
|
$3,764.00
|
|
|
Service Code
|
CPT 45136
|
| Hospital Charge Code |
6145136
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,027.57 |
| Max. Negotiated Rate |
$3,575.80 |
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cigna Commercial |
$3,199.40
|
| Rate for Payer: First Health Commercial |
$3,387.60
|
| Rate for Payer: First Health Workers Compensation |
$1,453.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,387.60
|
| Rate for Payer: GEHA Commercial |
$2,634.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,387.60
|
| Rate for Payer: Multiplan All |
$3,425.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,634.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,387.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,575.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,823.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,500.52
|
| Rate for Payer: Zelis Auto |
$1,505.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,027.57
|
|
|
EXCISE ILEOANAL RESERVIOR
|
Facility
|
OP
|
$3,764.00
|
|
|
Service Code
|
CPT 45136
|
| Hospital Charge Code |
6145136
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$941.00 |
| Max. Negotiated Rate |
$3,575.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,258.40
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cigna Commercial |
$3,199.40
|
| Rate for Payer: First Health Commercial |
$3,387.60
|
| Rate for Payer: First Health Workers Compensation |
$1,453.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,387.60
|
| Rate for Payer: GEHA Commercial |
$3,011.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,387.60
|
| Rate for Payer: Humana ChoiceCare |
$978.64
|
| Rate for Payer: Multiplan All |
$3,425.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,258.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,634.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,387.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,575.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,823.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,312.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,500.52
|
| Rate for Payer: Zelis Auto |
$1,505.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,882.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,027.57
|
|
|
EXCISE INFERIOR TURBINATE
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 30130
|
| Hospital Charge Code |
6130130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$899.65 |
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$662.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: Zelis Auto |
$378.80
|
| Rate for Payer: Zelis Worker's Compensation |
$258.53
|
|
|
EXCISE INFERIOR TURBINATE
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 30130
|
| Hospital Charge Code |
6130130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$568.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$757.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$378.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$258.53
|
|
|
EXCISE INTESTINE LESION(S)
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
CPT 44110
|
| Hospital Charge Code |
6144110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$488.67 |
| Max. Negotiated Rate |
$1,700.50 |
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$1,521.50
|
| Rate for Payer: First Health Commercial |
$1,611.00
|
| Rate for Payer: First Health Workers Compensation |
$691.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,611.00
|
| Rate for Payer: GEHA Commercial |
$1,253.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,611.00
|
| Rate for Payer: Multiplan All |
$1,628.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,253.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,611.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,700.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,342.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,664.70
|
| Rate for Payer: Zelis Auto |
$716.00
|
| Rate for Payer: Zelis Worker's Compensation |
$488.67
|
|
|
EXCISE INTESTINE LESION(S)
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
CPT 44110
|
| Hospital Charge Code |
6144110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$1,700.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,074.00
|
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$1,521.50
|
| Rate for Payer: First Health Commercial |
$1,611.00
|
| Rate for Payer: First Health Workers Compensation |
$691.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,611.00
|
| Rate for Payer: GEHA Commercial |
$1,432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,611.00
|
| Rate for Payer: Humana ChoiceCare |
$465.40
|
| Rate for Payer: Multiplan All |
$1,628.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,074.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,253.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,611.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,700.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,342.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,575.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$447.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,664.70
|
| Rate for Payer: Zelis Auto |
$716.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$895.00
|
| Rate for Payer: Zelis Worker's Compensation |
$488.67
|
|
|
EXCISE INTRSPINL LESION SCRL
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
CPT 63273
|
| Hospital Charge Code |
6163273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,001.25 |
| Max. Negotiated Rate |
$3,804.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,403.00
|
| Rate for Payer: Cash Price |
$2,403.00
|
| Rate for Payer: Cigna Commercial |
$3,404.25
|
| Rate for Payer: First Health Commercial |
$3,604.50
|
| Rate for Payer: First Health Workers Compensation |
$1,546.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,604.50
|
| Rate for Payer: GEHA Commercial |
$3,204.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,604.50
|
| Rate for Payer: Humana ChoiceCare |
$1,041.30
|
| Rate for Payer: Multiplan All |
$3,644.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,403.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,803.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,604.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,804.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,003.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,524.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,001.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,724.65
|
| Rate for Payer: Zelis Auto |
$1,602.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,002.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,093.37
|
|
|
EXCISE INTRSPINL LESION SCRL
|
Facility
|
IP
|
$4,005.00
|
|
|
Service Code
|
CPT 63273
|
| Hospital Charge Code |
6163273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,093.37 |
| Max. Negotiated Rate |
$3,804.75 |
| Rate for Payer: Cash Price |
$2,403.00
|
| Rate for Payer: Cigna Commercial |
$3,404.25
|
| Rate for Payer: First Health Commercial |
$3,604.50
|
| Rate for Payer: First Health Workers Compensation |
$1,546.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,604.50
|
| Rate for Payer: GEHA Commercial |
$2,803.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,604.50
|
| Rate for Payer: Multiplan All |
$3,644.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,803.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,604.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,804.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,003.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,724.65
|
| Rate for Payer: Zelis Auto |
$1,602.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,093.37
|
|
|
EXCISE LESION TESTIS
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 54512
|
| Hospital Charge Code |
6154512
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$303.03 |
| Max. Negotiated Rate |
$1,054.50 |
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$943.50
|
| Rate for Payer: First Health Commercial |
$999.00
|
| Rate for Payer: First Health Workers Compensation |
$428.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$999.00
|
| Rate for Payer: GEHA Commercial |
$777.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$999.00
|
| Rate for Payer: Multiplan All |
$1,010.10
|
| Rate for Payer: OMNI Networks Commercial |
$777.00
|
| Rate for Payer: One Health Plan PPO/POS |
$999.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,054.50
|
| Rate for Payer: Three Rivers Provider Network All |
$832.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,032.30
|
| Rate for Payer: Zelis Auto |
$444.00
|
| Rate for Payer: Zelis Worker's Compensation |
$303.03
|
|
|
EXCISE LESION TESTIS
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 54512
|
| Hospital Charge Code |
6154512
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$303.03 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$666.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$943.50
|
| Rate for Payer: First Health Commercial |
$999.00
|
| Rate for Payer: First Health Workers Compensation |
$428.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$999.00
|
| Rate for Payer: GEHA Commercial |
$888.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$999.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,010.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$777.00
|
| Rate for Payer: One Health Plan PPO/POS |
$999.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,054.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$832.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,032.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$444.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$303.03
|
|
|
EXCISE LIP OR CHEEK FOLD
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 40819
|
| Hospital Charge Code |
6140819
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.99 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$526.15
|
| Rate for Payer: First Health Commercial |
$557.10
|
| Rate for Payer: First Health Workers Compensation |
$239.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$557.10
|
| Rate for Payer: GEHA Commercial |
$433.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$557.10
|
| Rate for Payer: Multiplan All |
$563.29
|
| Rate for Payer: OMNI Networks Commercial |
$433.30
|
| Rate for Payer: One Health Plan PPO/POS |
$557.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$588.05
|
| Rate for Payer: Three Rivers Provider Network All |
$464.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$575.67
|
| Rate for Payer: Zelis Auto |
$247.60
|
| Rate for Payer: Zelis Worker's Compensation |
$168.99
|
|
|
EXCISE LIP OR CHEEK FOLD
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 40819
|
| Hospital Charge Code |
6140819
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.99 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$371.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$526.15
|
| Rate for Payer: First Health Commercial |
$557.10
|
| Rate for Payer: First Health Workers Compensation |
$239.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$557.10
|
| Rate for Payer: GEHA Commercial |
$495.20
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$557.10
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$563.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$433.30
|
| Rate for Payer: One Health Plan PPO/POS |
$557.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$588.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$464.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$575.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$247.60
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$168.99
|
|
|
EXCISE LWR JAW CYST W/REPAIR
|
Facility
|
IP
|
$2,737.00
|
|
|
Service Code
|
CPT 21047
|
| Hospital Charge Code |
6121047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$747.20 |
| Max. Negotiated Rate |
$2,600.15 |
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$2,326.45
|
| Rate for Payer: First Health Commercial |
$2,463.30
|
| Rate for Payer: First Health Workers Compensation |
$1,056.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,463.30
|
| Rate for Payer: GEHA Commercial |
$1,915.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,463.30
|
| Rate for Payer: Multiplan All |
$2,490.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,915.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,463.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,600.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,052.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,545.41
|
| Rate for Payer: Zelis Auto |
$1,094.80
|
| Rate for Payer: Zelis Worker's Compensation |
$747.20
|
|
|
EXCISE LWR JAW CYST W/REPAIR
|
Facility
|
OP
|
$2,737.00
|
|
|
Service Code
|
CPT 21047
|
| Hospital Charge Code |
6121047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$747.20 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,642.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$2,326.45
|
| Rate for Payer: First Health Commercial |
$2,463.30
|
| Rate for Payer: First Health Workers Compensation |
$1,056.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,463.30
|
| Rate for Payer: GEHA Commercial |
$2,189.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,463.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,490.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,915.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,463.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,600.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,052.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,545.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,094.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$747.20
|
|
|
EXCISE MANDIBLE LESION
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 21040
|
| Hospital Charge Code |
6121040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.96 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$514.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cigna Commercial |
$728.45
|
| Rate for Payer: First Health Commercial |
$771.30
|
| Rate for Payer: First Health Workers Compensation |
$330.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$771.30
|
| Rate for Payer: GEHA Commercial |
$685.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$771.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$779.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$599.90
|
| Rate for Payer: One Health Plan PPO/POS |
$771.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$814.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$642.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$797.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$342.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$233.96
|
|
|
EXCISE MANDIBLE LESION
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 21040
|
| Hospital Charge Code |
6121040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.96 |
| Max. Negotiated Rate |
$814.15 |
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cigna Commercial |
$728.45
|
| Rate for Payer: First Health Commercial |
$771.30
|
| Rate for Payer: First Health Workers Compensation |
$330.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$771.30
|
| Rate for Payer: GEHA Commercial |
$599.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$771.30
|
| Rate for Payer: Multiplan All |
$779.87
|
| Rate for Payer: OMNI Networks Commercial |
$599.90
|
| Rate for Payer: One Health Plan PPO/POS |
$771.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$814.15
|
| Rate for Payer: Three Rivers Provider Network All |
$642.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$797.01
|
| Rate for Payer: Zelis Auto |
$342.80
|
| Rate for Payer: Zelis Worker's Compensation |
$233.96
|
|
|
EXCISE MAX/ZYGOMA B9 TUMOR
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 21030
|
| Hospital Charge Code |
6121030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.69 |
| Max. Negotiated Rate |
$813.20 |
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$727.60
|
| Rate for Payer: First Health Commercial |
$770.40
|
| Rate for Payer: First Health Workers Compensation |
$330.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$770.40
|
| Rate for Payer: GEHA Commercial |
$599.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$770.40
|
| Rate for Payer: Multiplan All |
$778.96
|
| Rate for Payer: OMNI Networks Commercial |
$599.20
|
| Rate for Payer: One Health Plan PPO/POS |
$770.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$813.20
|
| Rate for Payer: Three Rivers Provider Network All |
$642.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$796.08
|
| Rate for Payer: Zelis Auto |
$342.40
|
| Rate for Payer: Zelis Worker's Compensation |
$233.69
|
|
|
EXCISE MAX/ZYGOMA B9 TUMOR
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 21030
|
| Hospital Charge Code |
6121030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.69 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$513.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$727.60
|
| Rate for Payer: First Health Commercial |
$770.40
|
| Rate for Payer: First Health Workers Compensation |
$330.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$770.40
|
| Rate for Payer: GEHA Commercial |
$684.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$770.40
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$778.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$599.20
|
| Rate for Payer: One Health Plan PPO/POS |
$770.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$813.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$642.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$796.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$342.40
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$233.69
|
|
|
EXCISE MAX/ZYGOMA MAL TUMOR
|
Facility
|
IP
|
$2,390.00
|
|
|
Service Code
|
CPT 21034
|
| Hospital Charge Code |
6121034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$652.47 |
| Max. Negotiated Rate |
$2,270.50 |
| Rate for Payer: Cash Price |
$1,434.00
|
| Rate for Payer: Cigna Commercial |
$2,031.50
|
| Rate for Payer: First Health Commercial |
$2,151.00
|
| Rate for Payer: First Health Workers Compensation |
$922.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,151.00
|
| Rate for Payer: GEHA Commercial |
$1,673.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,151.00
|
| Rate for Payer: Multiplan All |
$2,174.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,673.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,151.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,270.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,792.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,222.70
|
| Rate for Payer: Zelis Auto |
$956.00
|
| Rate for Payer: Zelis Worker's Compensation |
$652.47
|
|
|
EXCISE MAX/ZYGOMA MAL TUMOR
|
Facility
|
OP
|
$2,390.00
|
|
|
Service Code
|
CPT 21034
|
| Hospital Charge Code |
6121034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$652.47 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,434.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,434.00
|
| Rate for Payer: Cash Price |
$1,434.00
|
| Rate for Payer: Cigna Commercial |
$2,031.50
|
| Rate for Payer: First Health Commercial |
$2,151.00
|
| Rate for Payer: First Health Workers Compensation |
$922.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,151.00
|
| Rate for Payer: GEHA Commercial |
$1,912.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,151.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,174.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,673.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,151.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,270.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,792.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,222.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$956.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$652.47
|
|
|
EXCISE PAROTID GLAND/LESION
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
CPT 42425
|
| Hospital Charge Code |
6142425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.20 |
| Max. Negotiated Rate |
$1,650.15 |
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna Commercial |
$1,476.45
|
| Rate for Payer: First Health Commercial |
$1,563.30
|
| Rate for Payer: First Health Workers Compensation |
$670.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,563.30
|
| Rate for Payer: GEHA Commercial |
$1,215.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,563.30
|
| Rate for Payer: Multiplan All |
$1,580.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,215.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,563.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,650.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,615.41
|
| Rate for Payer: Zelis Auto |
$694.80
|
| Rate for Payer: Zelis Worker's Compensation |
$474.20
|
|
|
EXCISE PAROTID GLAND/LESION
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
CPT 42426
|
| Hospital Charge Code |
6142426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$703.00 |
| Max. Negotiated Rate |
$2,671.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,687.20
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cigna Commercial |
$2,390.20
|
| Rate for Payer: First Health Commercial |
$2,530.80
|
| Rate for Payer: First Health Workers Compensation |
$1,085.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,530.80
|
| Rate for Payer: GEHA Commercial |
$2,249.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,530.80
|
| Rate for Payer: Humana ChoiceCare |
$731.12
|
| Rate for Payer: Multiplan All |
$2,558.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,687.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,968.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,530.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,671.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,109.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,474.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$703.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,615.16
|
| Rate for Payer: Zelis Auto |
$1,124.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,406.00
|
| Rate for Payer: Zelis Worker's Compensation |
$767.68
|
|
|
EXCISE PAROTID GLAND/LESION
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
CPT 42415
|
| Hospital Charge Code |
6142415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$599.51 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,317.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cigna Commercial |
$1,866.60
|
| Rate for Payer: First Health Commercial |
$1,976.40
|
| Rate for Payer: First Health Workers Compensation |
$847.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,976.40
|
| Rate for Payer: GEHA Commercial |
$1,756.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,976.40
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,998.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,537.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,976.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,086.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,647.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,042.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$878.40
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$599.51
|
|
