|
EXCISION OF MESENTERY LESION
|
Facility
|
OP
|
$1,761.00
|
|
|
Service Code
|
CPT 44820
|
| Hospital Charge Code |
6144820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$440.25 |
| Max. Negotiated Rate |
$1,672.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cigna Commercial |
$1,496.85
|
| Rate for Payer: First Health Commercial |
$1,584.90
|
| Rate for Payer: First Health Workers Compensation |
$679.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,584.90
|
| Rate for Payer: GEHA Commercial |
$1,408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,584.90
|
| Rate for Payer: Humana ChoiceCare |
$457.86
|
| Rate for Payer: Multiplan All |
$1,602.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,056.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,232.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,584.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,672.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,320.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,549.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,637.73
|
| Rate for Payer: Zelis Auto |
$704.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$880.50
|
| Rate for Payer: Zelis Worker's Compensation |
$480.75
|
|
|
EXCISION OF MESENTERY LESION
|
Facility
|
IP
|
$1,761.00
|
|
|
Service Code
|
CPT 44820
|
| Hospital Charge Code |
6144820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.75 |
| Max. Negotiated Rate |
$1,672.95 |
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cigna Commercial |
$1,496.85
|
| Rate for Payer: First Health Commercial |
$1,584.90
|
| Rate for Payer: First Health Workers Compensation |
$679.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,584.90
|
| Rate for Payer: GEHA Commercial |
$1,232.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,584.90
|
| Rate for Payer: Multiplan All |
$1,602.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,232.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,584.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,672.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,320.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,637.73
|
| Rate for Payer: Zelis Auto |
$704.40
|
| Rate for Payer: Zelis Worker's Compensation |
$480.75
|
|
|
EXCISION OF MOUTH LESION
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
6140810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$334.90
|
| Rate for Payer: First Health Commercial |
$354.60
|
| Rate for Payer: First Health Workers Compensation |
$152.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$354.60
|
| Rate for Payer: GEHA Commercial |
$275.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$354.60
|
| Rate for Payer: Multiplan All |
$358.54
|
| Rate for Payer: OMNI Networks Commercial |
$275.80
|
| Rate for Payer: One Health Plan PPO/POS |
$354.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$374.30
|
| Rate for Payer: Three Rivers Provider Network All |
$295.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$366.42
|
| Rate for Payer: Zelis Auto |
$157.60
|
| Rate for Payer: Zelis Worker's Compensation |
$107.56
|
|
|
EXCISION OF MOUTH LESION
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 41116
|
| Hospital Charge Code |
6141116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$6,284.94 |
| 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 |
$340.80
|
| 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 |
$3,142.47
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$482.80
|
| Rate for Payer: First Health Commercial |
$511.20
|
| Rate for Payer: First Health Workers Compensation |
$219.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.20
|
| Rate for Payer: GEHA Commercial |
$454.40
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.20
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$516.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$397.60
|
| Rate for Payer: One Health Plan PPO/POS |
$511.20
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$539.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$426.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$227.20
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$155.06
|
|
|
EXCISION OF MOUTH LESION
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 41116
|
| Hospital Charge Code |
6141116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$482.80
|
| Rate for Payer: First Health Commercial |
$511.20
|
| Rate for Payer: First Health Workers Compensation |
$219.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.20
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.20
|
| Rate for Payer: Multiplan All |
$516.88
|
| Rate for Payer: OMNI Networks Commercial |
$397.60
|
| Rate for Payer: One Health Plan PPO/POS |
$511.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$539.60
|
| Rate for Payer: Three Rivers Provider Network All |
$426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.24
|
| Rate for Payer: Zelis Auto |
$227.20
|
| Rate for Payer: Zelis Worker's Compensation |
$155.06
|
|
|
EXCISION OF MOUTH LESION
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
6140810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$6,284.94 |
| 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 |
$236.40
|
| 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 |
$3,142.47
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$334.90
|
| Rate for Payer: First Health Commercial |
$354.60
|
| Rate for Payer: First Health Workers Compensation |
$152.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$354.60
|
| Rate for Payer: GEHA Commercial |
$315.20
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$354.60
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$358.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$275.80
|
| Rate for Payer: One Health Plan PPO/POS |
$354.60
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$374.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$295.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$366.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$157.60
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$107.56
|
|
|
EXCISION OF NAIL AND NAIL MATRIX, PARTIA
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
211750
|
|
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 OF NECK CYST
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 42815
|
| Hospital Charge Code |
6142815
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$1,092.50 |
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$977.50
|
| Rate for Payer: First Health Commercial |
$1,035.00
|
| Rate for Payer: First Health Workers Compensation |
$444.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.00
|
| Rate for Payer: GEHA Commercial |
$805.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: Zelis Auto |
$460.00
|
| Rate for Payer: Zelis Worker's Compensation |
$313.95
|
|
|
EXCISION OF NECK CYST
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 42810
|
| Hospital Charge Code |
6142810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$6,284.94 |
| 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 |
$443.40
|
| 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 |
$3,142.47
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$628.15
|
| Rate for Payer: First Health Commercial |
$665.10
|
| Rate for Payer: First Health Workers Compensation |
$285.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$665.10
|
| Rate for Payer: GEHA Commercial |
$591.20
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$665.10
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$672.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$517.30
|
| Rate for Payer: One Health Plan PPO/POS |
$665.10
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$702.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$554.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$687.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$295.60
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$201.75
|
|
|
EXCISION OF NECK CYST
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 42810
|
| Hospital Charge Code |
6142810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$628.15
|
| Rate for Payer: First Health Commercial |
$665.10
|
| Rate for Payer: First Health Workers Compensation |
$285.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$665.10
|
| Rate for Payer: GEHA Commercial |
$517.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$665.10
|
| Rate for Payer: Multiplan All |
$672.49
|
| Rate for Payer: OMNI Networks Commercial |
$517.30
|
| Rate for Payer: One Health Plan PPO/POS |
$665.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$702.05
|
| Rate for Payer: Three Rivers Provider Network All |
$554.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$687.27
|
| Rate for Payer: Zelis Auto |
$295.60
|
| Rate for Payer: Zelis Worker's Compensation |
$201.75
|
|
|
EXCISION OF NECK CYST
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 42815
|
| Hospital Charge Code |
6142815
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,732.16
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$977.50
|
| Rate for Payer: First Health Commercial |
$1,035.00
|
| Rate for Payer: First Health Workers Compensation |
$444.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.00
|
| Rate for Payer: GEHA Commercial |
$920.00
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$460.00
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$313.95
|
|
|
EXCISION OF PENIS LESION(S)
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 54060
|
| Hospital Charge Code |
6154060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: First Health Workers Compensation |
$154.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$279.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: Zelis Auto |
$159.60
|
| Rate for Payer: Zelis Worker's Compensation |
$108.93
|
|
|
EXCISION OF PENIS LESION(S)
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 54060
|
| Hospital Charge Code |
6154060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$3,544.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,772.49
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: First Health Workers Compensation |
$154.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$319.20
|
| Rate for Payer: GEHA Medicare |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$159.60
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$108.93
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED
|
Facility
|
OP
|
$5,546.54
|
|
|
Service Code
|
CPT 11772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.34 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: First Health Workers Compensation |
$3,569.20
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$2,523.68
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
|
Facility
|
OP
|
$5,546.54
|
|
|
Service Code
|
CPT 11771
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.34 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: First Health Workers Compensation |
$3,569.20
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$2,523.68
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
|
Facility
|
OP
|
$5,546.54
|
|
|
Service Code
|
CPT 11770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.34 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Zelis Worker's Compensation |
$2,523.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: First Health Workers Compensation |
$3,569.20
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
|
|
EXCISION OF RECTAL LESION
|
Facility
|
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 45160
|
| Hospital Charge Code |
6145160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$585.04 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,285.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$1,285.80
|
| Rate for Payer: Cash Price |
$1,285.80
|
| Rate for Payer: Cigna Commercial |
$1,821.55
|
| Rate for Payer: First Health Commercial |
$1,928.70
|
| Rate for Payer: First Health Workers Compensation |
$827.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,928.70
|
| Rate for Payer: GEHA Commercial |
$1,714.40
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,928.70
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,950.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,500.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,928.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,035.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,607.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$857.20
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$585.04
|
|
|
EXCISION OF RECTAL LESION
|
Facility
|
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 45160
|
| Hospital Charge Code |
6145160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$585.04 |
| Max. Negotiated Rate |
$2,035.85 |
| Rate for Payer: Cash Price |
$1,285.80
|
| Rate for Payer: Cigna Commercial |
$1,821.55
|
| Rate for Payer: First Health Commercial |
$1,928.70
|
| Rate for Payer: First Health Workers Compensation |
$827.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,928.70
|
| Rate for Payer: GEHA Commercial |
$1,500.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,928.70
|
| Rate for Payer: Multiplan All |
$1,950.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,500.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,928.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,035.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,607.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.99
|
| Rate for Payer: Zelis Auto |
$857.20
|
| Rate for Payer: Zelis Worker's Compensation |
$585.04
|
|
|
EXCISION OF RECTAL PROLAPSE
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
CPT 45130
|
| Hospital Charge Code |
6145130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$567.50 |
| Max. Negotiated Rate |
$2,156.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,362.00
|
| Rate for Payer: Cash Price |
$1,362.00
|
| Rate for Payer: Cigna Commercial |
$1,929.50
|
| Rate for Payer: First Health Commercial |
$2,043.00
|
| Rate for Payer: First Health Workers Compensation |
$876.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,043.00
|
| Rate for Payer: GEHA Commercial |
$1,816.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,043.00
|
| Rate for Payer: Humana ChoiceCare |
$590.20
|
| Rate for Payer: Multiplan All |
$2,065.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,362.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,589.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,043.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,156.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,702.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,997.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$567.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,111.10
|
| Rate for Payer: Zelis Auto |
$908.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,135.00
|
| Rate for Payer: Zelis Worker's Compensation |
$619.71
|
|
|
EXCISION OF RECTAL PROLAPSE
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
CPT 45130
|
| Hospital Charge Code |
6145130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$619.71 |
| Max. Negotiated Rate |
$2,156.50 |
| Rate for Payer: Cash Price |
$1,362.00
|
| Rate for Payer: Cigna Commercial |
$1,929.50
|
| Rate for Payer: First Health Commercial |
$2,043.00
|
| Rate for Payer: First Health Workers Compensation |
$876.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,043.00
|
| Rate for Payer: GEHA Commercial |
$1,589.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,043.00
|
| Rate for Payer: Multiplan All |
$2,065.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,589.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,043.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,156.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,702.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,111.10
|
| Rate for Payer: Zelis Auto |
$908.00
|
| Rate for Payer: Zelis Worker's Compensation |
$619.71
|
|
|
EXCISION OF RECTAL PROLAPSE
|
Facility
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 45135
|
| Hospital Charge Code |
6145135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$719.25 |
| Max. Negotiated Rate |
$2,733.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,726.20
|
| Rate for Payer: Cash Price |
$1,726.20
|
| Rate for Payer: Cigna Commercial |
$2,445.45
|
| Rate for Payer: First Health Commercial |
$2,589.30
|
| Rate for Payer: First Health Workers Compensation |
$1,110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,589.30
|
| Rate for Payer: GEHA Commercial |
$2,301.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,589.30
|
| Rate for Payer: Humana ChoiceCare |
$748.02
|
| Rate for Payer: Multiplan All |
$2,618.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,726.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,013.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,589.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,733.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,157.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,531.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$719.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,675.61
|
| Rate for Payer: Zelis Auto |
$1,150.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,438.50
|
| Rate for Payer: Zelis Worker's Compensation |
$785.42
|
|
|
EXCISION OF RECTAL PROLAPSE
|
Facility
|
IP
|
$2,877.00
|
|
|
Service Code
|
CPT 45135
|
| Hospital Charge Code |
6145135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$785.42 |
| Max. Negotiated Rate |
$2,733.15 |
| Rate for Payer: Cash Price |
$1,726.20
|
| Rate for Payer: Cigna Commercial |
$2,445.45
|
| Rate for Payer: First Health Commercial |
$2,589.30
|
| Rate for Payer: First Health Workers Compensation |
$1,110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,589.30
|
| Rate for Payer: GEHA Commercial |
$2,013.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,589.30
|
| Rate for Payer: Multiplan All |
$2,618.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,013.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,589.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,733.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,157.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,675.61
|
| Rate for Payer: Zelis Auto |
$1,150.80
|
| Rate for Payer: Zelis Worker's Compensation |
$785.42
|
|
|
EXCISION OF RECTAL STRICTURE
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 45150
|
| Hospital Charge Code |
6145150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$702.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
EXCISION OF RECTAL STRICTURE
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 45150
|
| Hospital Charge Code |
6145150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$2,423.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$601.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,142.50
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$802.40
|
| Rate for Payer: GEHA Medicare |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Humana ChoiceCare |
$1,256.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,142.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,919.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,142.50
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Medicare |
$971.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.00
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY
|
Facility
|
OP
|
$3,969.94
|
|
|
Service Code
|
CPT 54840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,687.22 |
| Max. Negotiated Rate |
$3,969.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| Rate for Payer: First Health Workers Compensation |
$2,554.66
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$1,806.32
|
|
