|
EXCISION OF BILE DUCT TUMOR
|
Facility
|
OP
|
$4,192.00
|
|
|
Service Code
|
CPT 47712
|
| Hospital Charge Code |
6147712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,048.00 |
| Max. Negotiated Rate |
$3,982.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,515.20
|
| 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 |
$3,353.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,772.80
|
| Rate for Payer: Humana ChoiceCare |
$1,089.92
|
| Rate for Payer: Multiplan All |
$3,814.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,515.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$3,688.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,048.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,898.56
|
| Rate for Payer: Zelis Auto |
$1,676.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,096.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,144.42
|
|
|
EXCISION OF BILE DUCT TUMOR
|
Facility
|
IP
|
$3,273.00
|
|
|
Service Code
|
CPT 47711
|
| Hospital Charge Code |
6147711
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$893.53 |
| Max. Negotiated Rate |
$3,109.35 |
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Cigna Commercial |
$2,782.05
|
| Rate for Payer: First Health Commercial |
$2,945.70
|
| Rate for Payer: First Health Workers Compensation |
$1,263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,945.70
|
| Rate for Payer: GEHA Commercial |
$2,291.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,945.70
|
| Rate for Payer: Multiplan All |
$2,978.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,291.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,945.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,109.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,043.89
|
| Rate for Payer: Zelis Auto |
$1,309.20
|
| Rate for Payer: Zelis Worker's Compensation |
$893.53
|
|
|
EXCISION OF BILE DUCT TUMOR
|
Facility
|
OP
|
$3,273.00
|
|
|
Service Code
|
CPT 47711
|
| Hospital Charge Code |
6147711
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$818.25 |
| Max. Negotiated Rate |
$3,109.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,963.80
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Cigna Commercial |
$2,782.05
|
| Rate for Payer: First Health Commercial |
$2,945.70
|
| Rate for Payer: First Health Workers Compensation |
$1,263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,945.70
|
| Rate for Payer: GEHA Commercial |
$2,618.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,945.70
|
| Rate for Payer: Humana ChoiceCare |
$850.98
|
| Rate for Payer: Multiplan All |
$2,978.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,963.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,291.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,945.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,109.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,454.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,880.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$818.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,043.89
|
| Rate for Payer: Zelis Auto |
$1,309.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,636.50
|
| Rate for Payer: Zelis Worker's Compensation |
$893.53
|
|
|
EXCISION OF BONE LOWER JAW
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 21025
|
| Hospital Charge Code |
6121025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.88 |
| 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 |
$929.40
|
| 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 |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$1,316.65
|
| Rate for Payer: First Health Commercial |
$1,394.10
|
| Rate for Payer: First Health Workers Compensation |
$598.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,394.10
|
| Rate for Payer: GEHA Commercial |
$1,239.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,394.10
|
| 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 |
$1,409.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,084.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,394.10
|
| 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 |
$1,471.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,161.75
|
| 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 |
$1,440.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$619.60
|
| 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 |
$422.88
|
|
|
EXCISION OF BONE LOWER JAW
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 21025
|
| Hospital Charge Code |
6121025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.88 |
| Max. Negotiated Rate |
$1,471.55 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$1,316.65
|
| Rate for Payer: First Health Commercial |
$1,394.10
|
| Rate for Payer: First Health Workers Compensation |
$598.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,394.10
|
| Rate for Payer: GEHA Commercial |
$1,084.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,394.10
|
| Rate for Payer: Multiplan All |
$1,409.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,084.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,394.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,471.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,161.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,440.57
|
| Rate for Payer: Zelis Auto |
$619.60
|
| Rate for Payer: Zelis Worker's Compensation |
$422.88
|
|
|
EXCISION OF BOWEL LESION(S)
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT 44111
|
| Hospital Charge Code |
6144111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$517.50 |
| Max. Negotiated Rate |
$1,966.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cigna Commercial |
$1,759.50
|
| Rate for Payer: First Health Commercial |
$1,863.00
|
| Rate for Payer: First Health Workers Compensation |
$799.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,863.00
|
| Rate for Payer: GEHA Commercial |
$1,656.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,863.00
|
| Rate for Payer: Humana ChoiceCare |
$538.20
|
| Rate for Payer: Multiplan All |
$1,883.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,242.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,449.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,863.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,966.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,552.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,821.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$517.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,925.10
|
| Rate for Payer: Zelis Auto |
$828.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.00
|
| Rate for Payer: Zelis Worker's Compensation |
$565.11
|
|
|
EXCISION OF BOWEL LESION(S)
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT 44111
|
| Hospital Charge Code |
6144111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$565.11 |
| Max. Negotiated Rate |
$1,966.50 |
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cigna Commercial |
$1,759.50
|
| Rate for Payer: First Health Commercial |
$1,863.00
|
| Rate for Payer: First Health Workers Compensation |
$799.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,863.00
|
| Rate for Payer: GEHA Commercial |
$1,449.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,863.00
|
| Rate for Payer: Multiplan All |
$1,883.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,449.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,863.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,966.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,552.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,925.10
|
| Rate for Payer: Zelis Auto |
$828.00
|
| Rate for Payer: Zelis Worker's Compensation |
$565.11
|
|
|
EXCISION OF BOWEL POUCH
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
6144800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$594.59 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna Commercial |
$1,851.30
|
| Rate for Payer: First Health Commercial |
$1,960.20
|
| Rate for Payer: First Health Workers Compensation |
$840.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,960.20
|
| Rate for Payer: GEHA Commercial |
$1,524.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,960.20
|
| Rate for Payer: Multiplan All |
$1,981.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,524.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,960.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,069.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,633.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,025.54
|
| Rate for Payer: Zelis Auto |
$871.20
|
| Rate for Payer: Zelis Worker's Compensation |
$594.59
|
|
|
EXCISION OF BOWEL POUCH
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
6144800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$544.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna Commercial |
$1,851.30
|
| Rate for Payer: First Health Commercial |
$1,960.20
|
| Rate for Payer: First Health Workers Compensation |
$840.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,960.20
|
| Rate for Payer: GEHA Commercial |
$1,742.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,960.20
|
| Rate for Payer: Humana ChoiceCare |
$566.28
|
| Rate for Payer: Multiplan All |
$1,981.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,306.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,524.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,960.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,069.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,633.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,916.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$544.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,025.54
|
| Rate for Payer: Zelis Auto |
$871.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,089.00
|
| Rate for Payer: Zelis Worker's Compensation |
$594.59
|
|
|
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, 1 OR MORE LESIONS
|
Facility
|
OP
|
$7,272.10
|
|
|
Service Code
|
CPT 19120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,982.57 |
| Max. Negotiated Rate |
$7,272.10 |
| 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 Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: First Health Workers Compensation |
$4,679.60
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$3,308.81
|
|
|
EXCISION OF ESOPHAGUS LESION
|
Facility
|
OP
|
$2,148.00
|
|
|
Service Code
|
CPT 43101
|
| Hospital Charge Code |
6143101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Humana ChoiceCare |
$558.48
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,288.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,890.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$537.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,074.00
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
EXCISION OF ESOPHAGUS LESION
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 43100
|
| Hospital Charge Code |
6143100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$323.50 |
| Max. Negotiated Rate |
$1,229.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$776.40
|
| Rate for Payer: Cash Price |
$776.40
|
| Rate for Payer: Cigna Commercial |
$1,099.90
|
| Rate for Payer: First Health Commercial |
$1,164.60
|
| Rate for Payer: First Health Workers Compensation |
$499.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,164.60
|
| Rate for Payer: GEHA Commercial |
$1,035.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,164.60
|
| Rate for Payer: Humana ChoiceCare |
$336.44
|
| Rate for Payer: Multiplan All |
$1,177.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$776.40
|
| Rate for Payer: OMNI Networks Commercial |
$905.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,164.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,229.30
|
| Rate for Payer: Three Rivers Provider Network All |
$970.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,138.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$323.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,203.42
|
| Rate for Payer: Zelis Auto |
$517.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$647.00
|
| Rate for Payer: Zelis Worker's Compensation |
$353.26
|
|
|
EXCISION OF ESOPHAGUS LESION
|
Facility
|
IP
|
$2,148.00
|
|
|
Service Code
|
CPT 43101
|
| Hospital Charge Code |
6143101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,503.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
EXCISION OF ESOPHAGUS LESION
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 43100
|
| Hospital Charge Code |
6143100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.26 |
| Max. Negotiated Rate |
$1,229.30 |
| Rate for Payer: Cash Price |
$776.40
|
| Rate for Payer: Cigna Commercial |
$1,099.90
|
| Rate for Payer: First Health Commercial |
$1,164.60
|
| Rate for Payer: First Health Workers Compensation |
$499.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,164.60
|
| Rate for Payer: GEHA Commercial |
$905.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,164.60
|
| Rate for Payer: Multiplan All |
$1,177.54
|
| Rate for Payer: OMNI Networks Commercial |
$905.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,164.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,229.30
|
| Rate for Payer: Three Rivers Provider Network All |
$970.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,203.42
|
| Rate for Payer: Zelis Auto |
$517.60
|
| Rate for Payer: Zelis Worker's Compensation |
$353.26
|
|
|
EXCISION OF FACIAL BONE(S)
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 21026
|
| Hospital Charge Code |
6121026
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.37 |
| 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 |
$609.60
|
| 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 |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$863.60
|
| Rate for Payer: First Health Commercial |
$914.40
|
| Rate for Payer: First Health Workers Compensation |
$392.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$914.40
|
| Rate for Payer: GEHA Commercial |
$812.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$914.40
|
| 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 |
$924.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$711.20
|
| Rate for Payer: One Health Plan PPO/POS |
$914.40
|
| 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 |
$965.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$762.00
|
| 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 |
$944.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$406.40
|
| 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 |
$277.37
|
|
|
EXCISION OF FACIAL BONE(S)
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 21026
|
| Hospital Charge Code |
6121026
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$965.20 |
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$863.60
|
| Rate for Payer: First Health Commercial |
$914.40
|
| Rate for Payer: First Health Workers Compensation |
$392.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$914.40
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$914.40
|
| Rate for Payer: Multiplan All |
$924.56
|
| Rate for Payer: OMNI Networks Commercial |
$711.20
|
| Rate for Payer: One Health Plan PPO/POS |
$914.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$965.20
|
| Rate for Payer: Three Rivers Provider Network All |
$762.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$944.88
|
| Rate for Payer: Zelis Auto |
$406.40
|
| Rate for Payer: Zelis Worker's Compensation |
$277.37
|
|
|
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
|
Facility
|
OP
|
$3,039.30
|
|
|
Service Code
|
CPT 25111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 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 |
$1,519.65
|
| Rate for Payer: First Health Workers Compensation |
$1,955.79
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| 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 |
$1,382.88
|
|
|
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT
|
Facility
|
OP
|
$3,039.30
|
|
|
Service Code
|
CPT 25112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 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 |
$1,519.65
|
| Rate for Payer: First Health Workers Compensation |
$1,955.79
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| 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 |
$1,382.88
|
|
|
EXCISION OF HIP JOINT/MUSCLE
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
CPT 27036
|
| Hospital Charge Code |
6127036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$566.48 |
| Max. Negotiated Rate |
$1,971.25 |
| Rate for Payer: Cash Price |
$1,245.00
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$1,867.50
|
| Rate for Payer: First Health Workers Compensation |
$801.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,867.50
|
| Rate for Payer: GEHA Commercial |
$1,452.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,867.50
|
| Rate for Payer: Multiplan All |
$1,888.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,452.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,867.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,971.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,929.75
|
| Rate for Payer: Zelis Auto |
$830.00
|
| Rate for Payer: Zelis Worker's Compensation |
$566.48
|
|
|
EXCISION OF HIP JOINT/MUSCLE
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
CPT 27036
|
| Hospital Charge Code |
6127036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$518.75 |
| Max. Negotiated Rate |
$1,971.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,245.00
|
| Rate for Payer: Cash Price |
$1,245.00
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$1,867.50
|
| Rate for Payer: First Health Workers Compensation |
$801.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,867.50
|
| Rate for Payer: GEHA Commercial |
$1,660.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,867.50
|
| Rate for Payer: Humana ChoiceCare |
$539.50
|
| Rate for Payer: Multiplan All |
$1,888.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,245.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,452.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,867.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,971.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,556.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,826.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$518.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,929.75
|
| Rate for Payer: Zelis Auto |
$830.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,037.50
|
| Rate for Payer: Zelis Worker's Compensation |
$566.48
|
|
|
EXCISION OF HYDROCELE; UNILATERAL
|
Facility
|
OP
|
$6,701.96
|
|
|
Service Code
|
CPT 55040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,560.61 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: First Health Workers Compensation |
$4,312.71
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3,049.39
|
|
|
EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST, GANGLION), KNEE
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 27347
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,763.37 |
| 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 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: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| 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: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 Worker's Compensation |
$6,161.78
|
| 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: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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
|
|
|
EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLION), HAND OR FINGER
|
Facility
|
OP
|
$3,039.30
|
|
|
Service Code
|
CPT 26160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: First Health Workers Compensation |
$1,955.79
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| 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 |
$1,382.88
|
|
|
EXCISION OF LINGUAL TONSIL
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT 42870
|
| Hospital Charge Code |
6142870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.88 |
| 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 |
$733.80
|
| 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 |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: First Health Workers Compensation |
$472.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| 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 |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| 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 |
$1,161.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| 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 |
$1,137.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$489.20
|
| 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 |
$333.88
|
|
|
EXCISION OF LINGUAL TONSIL
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT 42870
|
| Hospital Charge Code |
6142870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.88 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: First Health Workers Compensation |
$472.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Worker's Compensation |
$333.88
|
|
