|
EXCISE PAROTID GLAND/LESION
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
CPT 42426
|
| Hospital Charge Code |
6142426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$767.68 |
| Max. Negotiated Rate |
$2,671.40 |
| 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 |
$1,968.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,530.80
|
| Rate for Payer: Multiplan All |
$2,558.92
|
| 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: United Payors & United Providers UP&UP |
$2,615.16
|
| Rate for Payer: Zelis Auto |
$1,124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$767.68
|
|
|
EXCISE PAROTID GLAND/LESION
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 42425
|
| Hospital Charge Code |
6142425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.20 |
| 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 |
$1,042.20
|
| 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 |
$1,042.20
|
| 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 |
$1,389.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,563.30
|
| 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 |
$1,580.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,215.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,563.30
|
| 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 |
$1,650.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.75
|
| 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 |
$1,615.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$694.80
|
| 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 |
$474.20
|
|
|
EXCISE PAROTID GLAND/LESION
|
Facility
|
IP
|
$2,468.00
|
|
|
Service Code
|
CPT 42420
|
| Hospital Charge Code |
6142420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$673.76 |
| Max. Negotiated Rate |
$2,344.60 |
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cigna Commercial |
$2,097.80
|
| Rate for Payer: First Health Commercial |
$2,221.20
|
| Rate for Payer: First Health Workers Compensation |
$952.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,221.20
|
| Rate for Payer: GEHA Commercial |
$1,727.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,221.20
|
| Rate for Payer: Multiplan All |
$2,245.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,727.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,221.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,344.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,851.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,295.24
|
| Rate for Payer: Zelis Auto |
$987.20
|
| Rate for Payer: Zelis Worker's Compensation |
$673.76
|
|
|
EXCISE PAROTID GLAND/LESION
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
CPT 42415
|
| Hospital Charge Code |
6142415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$599.51 |
| Max. Negotiated Rate |
$2,086.20 |
| 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 |
$1,537.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,976.40
|
| Rate for Payer: Multiplan All |
$1,998.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,537.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,976.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,086.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,042.28
|
| Rate for Payer: Zelis Auto |
$878.40
|
| Rate for Payer: Zelis Worker's Compensation |
$599.51
|
|
|
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 PHARYNX LESION
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 42808
|
| Hospital Charge Code |
6142808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| 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 |
$302.40
|
| 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 |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| 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 |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| 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 |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| 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 |
$468.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$201.60
|
| 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 |
$137.59
|
|
|
EXCISE PHARYNX LESION
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 42808
|
| Hospital Charge Code |
6142808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
EXCISE/REPAIR MOUTH LESION
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT 40814
|
| Hospital Charge Code |
6140814
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$215.67 |
| 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 |
$474.00
|
| 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 |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: First Health Workers Compensation |
$305.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$632.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| 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 |
$718.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| 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 |
$750.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| 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 |
$734.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$316.00
|
| 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 |
$215.67
|
|
|
EXCISE/REPAIR MOUTH LESION
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
6140812
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$2,813.06 |
| 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 |
$307.80
|
| 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 |
$1,406.53
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$410.40
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| 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 |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| 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 |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$205.20
|
| 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 |
$140.05
|
|
|
EXCISE/REPAIR MOUTH LESION
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 40814
|
| Hospital Charge Code |
6140814
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$215.67 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: First Health Workers Compensation |
$305.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$553.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| Rate for Payer: Multiplan All |
$718.90
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$750.50
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$734.70
|
| Rate for Payer: Zelis Auto |
$316.00
|
| Rate for Payer: Zelis Worker's Compensation |
$215.67
|
|
|
EXCISE/REPAIR MOUTH LESION
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
6140812
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$359.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
EXCISE SACRAL SPINE TUMOR
|
Facility
|
OP
|
$4,662.00
|
|
|
Service Code
|
CPT 49215
|
| Hospital Charge Code |
6149215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,165.50 |
| Max. Negotiated Rate |
$4,428.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,797.20
|
| Rate for Payer: Cash Price |
$2,797.20
|
| Rate for Payer: Cigna Commercial |
$3,962.70
|
| Rate for Payer: First Health Commercial |
$4,195.80
|
| Rate for Payer: First Health Workers Compensation |
$1,800.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,195.80
|
| Rate for Payer: GEHA Commercial |
$3,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,195.80
|
| Rate for Payer: Humana ChoiceCare |
$1,212.12
|
| Rate for Payer: Multiplan All |
$4,242.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,797.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,263.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,195.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,428.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,496.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,102.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,165.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,335.66
|
| Rate for Payer: Zelis Auto |
$1,864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,331.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,272.73
|
|
|
EXCISE SACRAL SPINE TUMOR
|
Facility
|
IP
|
$4,662.00
|
|
|
Service Code
|
CPT 49215
|
| Hospital Charge Code |
6149215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,272.73 |
| Max. Negotiated Rate |
$4,428.90 |
| Rate for Payer: Cash Price |
$2,797.20
|
| Rate for Payer: Cigna Commercial |
$3,962.70
|
| Rate for Payer: First Health Commercial |
$4,195.80
|
| Rate for Payer: First Health Workers Compensation |
$1,800.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,195.80
|
| Rate for Payer: GEHA Commercial |
$3,263.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,195.80
|
| Rate for Payer: Multiplan All |
$4,242.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,263.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,195.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,428.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,496.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,335.66
|
| Rate for Payer: Zelis Auto |
$1,864.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,272.73
|
|
|
EXCISE SUBLINGUAL GLAND
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 42450
|
| Hospital Charge Code |
6142450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: First Health Workers Compensation |
$356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$646.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
| Rate for Payer: Zelis Worker's Compensation |
$252.25
|
|
|
EXCISE SUBLINGUAL GLAND
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 42450
|
| Hospital Charge Code |
6142450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.25 |
| 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 |
$554.40
|
| 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 |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: First Health Workers Compensation |
$356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| 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 |
$840.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| 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 |
$877.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| 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 |
$859.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$369.60
|
| 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 |
$252.25
|
|
|
EXCISE SUBMAXILLARY GLAND
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 42440
|
| Hospital Charge Code |
6142440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.14 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: First Health Workers Compensation |
$329.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$597.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| Rate for Payer: Multiplan All |
$777.14
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.30
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.22
|
| Rate for Payer: Zelis Auto |
$341.60
|
| Rate for Payer: Zelis Worker's Compensation |
$233.14
|
|
|
EXCISE SUBMAXILLARY GLAND
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 42440
|
| Hospital Charge Code |
6142440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.14 |
| 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 |
$512.40
|
| 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 |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: First Health Workers Compensation |
$329.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$683.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| 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 |
$777.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| 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 |
$811.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| 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 |
$794.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$341.60
|
| 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 |
$233.14
|
|
|
EXCISE TENDON FOREARM/WRIST
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
6125109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.57 |
| Max. Negotiated Rate |
$1,035.50 |
| Rate for Payer: Cash Price |
$654.00
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$981.00
|
| Rate for Payer: First Health Workers Compensation |
$420.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$981.00
|
| Rate for Payer: GEHA Commercial |
$763.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$981.00
|
| Rate for Payer: Multiplan All |
$991.90
|
| Rate for Payer: OMNI Networks Commercial |
$763.00
|
| Rate for Payer: One Health Plan PPO/POS |
$981.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,035.50
|
| Rate for Payer: Three Rivers Provider Network All |
$817.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,013.70
|
| Rate for Payer: Zelis Auto |
$436.00
|
| Rate for Payer: Zelis Worker's Compensation |
$297.57
|
|
|
EXCISE TENDON FOREARM/WRIST
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
6125109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.57 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$654.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$654.00
|
| Rate for Payer: Cash Price |
$654.00
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$981.00
|
| Rate for Payer: First Health Workers Compensation |
$420.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$981.00
|
| Rate for Payer: GEHA Commercial |
$872.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$981.00
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$991.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$763.00
|
| Rate for Payer: One Health Plan PPO/POS |
$981.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,035.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$817.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,013.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$436.00
|
| 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 |
$297.57
|
|
|
EXCISE TEND SHEATH/CAPSULE LEG/ANKLE
|
Facility
|
OP
|
$21,574.50
|
|
|
Service Code
|
CPT 27630
|
| Hospital Charge Code |
6128089
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,763.37 |
| Max. Negotiated Rate |
$20,495.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,944.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$12,944.70
|
| Rate for Payer: Cash Price |
$12,944.70
|
| Rate for Payer: Cigna Commercial |
$18,338.33
|
| Rate for Payer: First Health Commercial |
$19,417.05
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19,417.05
|
| Rate for Payer: GEHA Commercial |
$17,259.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19,417.05
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$19,632.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$15,102.15
|
| Rate for Payer: One Health Plan PPO/POS |
$19,417.05
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20,495.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$16,180.88
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,064.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$8,629.80
|
| 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 |
$2,803.61
|
|
|
EXCISE TEND SHEATH/CAPSULE LEG/ANKLE
|
Facility
|
IP
|
$21,574.50
|
|
|
Service Code
|
CPT 27630
|
| Hospital Charge Code |
6128089
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,889.84 |
| Max. Negotiated Rate |
$20,495.78 |
| Rate for Payer: Cash Price |
$12,944.70
|
| Rate for Payer: Cigna Commercial |
$18,338.33
|
| Rate for Payer: First Health Commercial |
$19,417.05
|
| Rate for Payer: First Health Workers Compensation |
$8,329.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19,417.05
|
| Rate for Payer: GEHA Commercial |
$15,102.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19,417.05
|
| Rate for Payer: Multiplan All |
$19,632.79
|
| Rate for Payer: OMNI Networks Commercial |
$15,102.15
|
| Rate for Payer: One Health Plan PPO/POS |
$19,417.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20,495.78
|
| Rate for Payer: Three Rivers Provider Network All |
$16,180.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,064.28
|
| Rate for Payer: Zelis Auto |
$8,629.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5,889.84
|
|
|
EXCISE WRIST TENDON SHEATH
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 25118
|
| Hospital Charge Code |
6125118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$371.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$673.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| Rate for Payer: Multiplan All |
$875.42
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$913.90
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$894.66
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Worker's Compensation |
$262.63
|
|
|
EXCISE WRIST TENDON SHEATH
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 25118
|
| Hospital Charge Code |
6125118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$3,212.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$577.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$371.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$769.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$875.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$913.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$894.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$262.63
|
|
|
EXCISION ADDL BREAST LESION
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 19126
|
| Hospital Charge Code |
6119126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$488.30 |
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$359.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
EXCISION ADDL BREAST LESION
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 19126
|
| Hospital Charge Code |
6119126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.64 |
| Max. Negotiated Rate |
$2,502.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$308.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$411.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Humana ChoiceCare |
$133.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$308.40
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$452.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
