|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
9611750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.46 |
| Max. Negotiated Rate |
$2,575.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,626.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$1,626.60
|
| Rate for Payer: Cash Price |
$1,626.60
|
| Rate for Payer: Cigna Commercial |
$2,304.35
|
| Rate for Payer: First Health Commercial |
$2,439.90
|
| Rate for Payer: First Health Workers Compensation |
$1,046.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,439.90
|
| Rate for Payer: GEHA Commercial |
$2,168.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,439.90
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$2,467.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,897.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,439.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,575.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,033.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,521.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$1,084.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$740.10
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
8711750
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
8711750
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
8150042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$700.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Humana ChoiceCare |
$227.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$525.00
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$770.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$437.50
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
6111750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
6111750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
9611750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$740.10 |
| Max. Negotiated Rate |
$2,575.45 |
| Rate for Payer: Cash Price |
$1,626.60
|
| Rate for Payer: Cigna Commercial |
$2,304.35
|
| Rate for Payer: First Health Commercial |
$2,439.90
|
| Rate for Payer: First Health Workers Compensation |
$1,046.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,439.90
|
| Rate for Payer: GEHA Commercial |
$1,897.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,439.90
|
| Rate for Payer: Multiplan All |
$2,467.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,897.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,439.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,575.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,033.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,521.23
|
| Rate for Payer: Zelis Auto |
$1,084.40
|
| Rate for Payer: Zelis Worker's Compensation |
$740.10
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$440.37
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
7211750
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$120.22 |
| Max. Negotiated Rate |
$418.35 |
| Rate for Payer: Cash Price |
$264.22
|
| Rate for Payer: Cigna Commercial |
$374.31
|
| Rate for Payer: First Health Commercial |
$396.33
|
| Rate for Payer: First Health Workers Compensation |
$170.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.33
|
| Rate for Payer: GEHA Commercial |
$308.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.33
|
| Rate for Payer: Multiplan All |
$400.74
|
| Rate for Payer: OMNI Networks Commercial |
$308.26
|
| Rate for Payer: One Health Plan PPO/POS |
$396.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.35
|
| Rate for Payer: Three Rivers Provider Network All |
$330.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$409.54
|
| Rate for Payer: Zelis Auto |
$176.15
|
| Rate for Payer: Zelis Worker's Compensation |
$120.22
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
20300023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
21600086
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
20300023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
1900023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.46 |
| Max. Negotiated Rate |
$2,614.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cigna Commercial |
$2,339.20
|
| Rate for Payer: First Health Commercial |
$2,476.80
|
| Rate for Payer: First Health Workers Compensation |
$1,062.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,476.80
|
| Rate for Payer: GEHA Commercial |
$2,201.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,476.80
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$2,504.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,926.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,476.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,614.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,559.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$1,100.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$751.30
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
1900023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$751.30 |
| Max. Negotiated Rate |
$2,614.40 |
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cigna Commercial |
$2,339.20
|
| Rate for Payer: First Health Commercial |
$2,476.80
|
| Rate for Payer: First Health Workers Compensation |
$1,062.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,476.80
|
| Rate for Payer: GEHA Commercial |
$1,926.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,476.80
|
| Rate for Payer: Multiplan All |
$2,504.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,926.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,476.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,614.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,559.36
|
| Rate for Payer: Zelis Auto |
$1,100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$751.30
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$440.37
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
8511750
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.22 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$264.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$264.22
|
| Rate for Payer: Cash Price |
$264.22
|
| Rate for Payer: Cigna Commercial |
$374.31
|
| Rate for Payer: First Health Commercial |
$396.33
|
| Rate for Payer: First Health Workers Compensation |
$170.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.33
|
| Rate for Payer: GEHA Commercial |
$352.30
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.33
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$400.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$308.26
|
| Rate for Payer: One Health Plan PPO/POS |
$396.33
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$330.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$409.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$176.15
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$120.22
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
8300017
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
8300017
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
8150042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$612.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
21600086
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Facility
|
OP
|
$440.37
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
7211750
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$120.22 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$264.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$264.22
|
| Rate for Payer: Cash Price |
$264.22
|
| Rate for Payer: Cigna Commercial |
$374.31
|
| Rate for Payer: First Health Commercial |
$396.33
|
| Rate for Payer: First Health Workers Compensation |
$170.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.33
|
| Rate for Payer: GEHA Commercial |
$352.30
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.33
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$400.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$308.26
|
| Rate for Payer: One Health Plan PPO/POS |
$396.33
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$330.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$409.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$176.15
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$120.22
|
|
|
EXCISION OF ANAL LESION(S)
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
6146922
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$404.70 |
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna Commercial |
$362.10
|
| Rate for Payer: First Health Commercial |
$383.40
|
| Rate for Payer: First Health Workers Compensation |
$164.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$383.40
|
| Rate for Payer: GEHA Commercial |
$298.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$383.40
|
| Rate for Payer: Multiplan All |
$387.66
|
| Rate for Payer: OMNI Networks Commercial |
$298.20
|
| Rate for Payer: One Health Plan PPO/POS |
$383.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$404.70
|
| Rate for Payer: Three Rivers Provider Network All |
$319.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$396.18
|
| Rate for Payer: Zelis Auto |
$170.40
|
| Rate for Payer: Zelis Worker's Compensation |
$116.30
|
|
|
EXCISION OF ANAL LESION(S)
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
6146922
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$255.60
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna Commercial |
$362.10
|
| Rate for Payer: First Health Commercial |
$383.40
|
| Rate for Payer: First Health Workers Compensation |
$164.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$383.40
|
| Rate for Payer: GEHA Commercial |
$340.80
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$383.40
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$387.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$298.20
|
| Rate for Payer: One Health Plan PPO/POS |
$383.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$404.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$319.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$396.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$170.40
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$116.30
|
|
|
EXCISION OF BARTHOLIN'S GLAND OR CYST
|
Facility
|
OP
|
$6,038.18
|
|
|
Service Code
|
CPT 56740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,605.60 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: First Health Workers Compensation |
$3,885.57
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$2,747.37
|
|
|
EXCISION OF BILE DUCT CYST
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
CPT 47715
|
| Hospital Charge Code |
6147715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$764.40 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cigna Commercial |
$2,380.00
|
| Rate for Payer: First Health Commercial |
$2,520.00
|
| Rate for Payer: First Health Workers Compensation |
$1,081.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,520.00
|
| Rate for Payer: GEHA Commercial |
$1,960.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,520.00
|
| Rate for Payer: Multiplan All |
$2,548.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,960.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,520.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,660.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,100.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,604.00
|
| Rate for Payer: Zelis Auto |
$1,120.00
|
| Rate for Payer: Zelis Worker's Compensation |
$764.40
|
|
|
EXCISION OF BILE DUCT CYST
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
CPT 47715
|
| Hospital Charge Code |
6147715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cigna Commercial |
$2,380.00
|
| Rate for Payer: First Health Commercial |
$2,520.00
|
| Rate for Payer: First Health Workers Compensation |
$1,081.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,520.00
|
| Rate for Payer: GEHA Commercial |
$2,240.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,520.00
|
| Rate for Payer: Humana ChoiceCare |
$728.00
|
| Rate for Payer: Multiplan All |
$2,548.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,680.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,960.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,520.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,660.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,464.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$700.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,604.00
|
| Rate for Payer: Zelis Auto |
$1,120.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,400.00
|
| Rate for Payer: Zelis Worker's Compensation |
$764.40
|
|
|
EXCISION OF BILE DUCT TUMOR
|
Facility
|
IP
|
$4,192.00
|
|
|
Service Code
|
CPT 47712
|
| Hospital Charge Code |
6147712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,144.42 |
| Max. Negotiated Rate |
$3,982.40 |
| Rate for Payer: Cash Price |
$2,515.20
|
| Rate for Payer: Cigna Commercial |
$3,563.20
|
| Rate for Payer: First Health Commercial |
$3,772.80
|
| Rate for Payer: First Health Workers Compensation |
$1,618.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,772.80
|
| Rate for Payer: GEHA Commercial |
$2,934.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,772.80
|
| Rate for Payer: Multiplan All |
$3,814.72
|
| Rate for Payer: OMNI Networks Commercial |
$2,934.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,772.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,982.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,898.56
|
| Rate for Payer: Zelis Auto |
$1,676.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,144.42
|
|
