|
EXCISION OF STOMACH LESION
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 43610
|
| Hospital Charge Code |
6143610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$515.50 |
| Max. Negotiated Rate |
$1,958.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,237.20
|
| Rate for Payer: Cash Price |
$1,237.20
|
| Rate for Payer: Cigna Commercial |
$1,752.70
|
| Rate for Payer: First Health Commercial |
$1,855.80
|
| Rate for Payer: First Health Workers Compensation |
$796.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,855.80
|
| Rate for Payer: GEHA Commercial |
$1,649.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,855.80
|
| Rate for Payer: Humana ChoiceCare |
$536.12
|
| Rate for Payer: Multiplan All |
$1,876.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,237.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,443.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,855.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,958.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,546.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,814.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$515.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,917.66
|
| Rate for Payer: Zelis Auto |
$824.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,031.00
|
| Rate for Payer: Zelis Worker's Compensation |
$562.93
|
|
|
EXCISION OF STOMACH LESION
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 43610
|
| Hospital Charge Code |
6143610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$562.93 |
| Max. Negotiated Rate |
$1,958.90 |
| Rate for Payer: Cash Price |
$1,237.20
|
| Rate for Payer: Cigna Commercial |
$1,752.70
|
| Rate for Payer: First Health Commercial |
$1,855.80
|
| Rate for Payer: First Health Workers Compensation |
$796.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,855.80
|
| Rate for Payer: GEHA Commercial |
$1,443.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,855.80
|
| Rate for Payer: Multiplan All |
$1,876.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,443.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,855.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,958.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,546.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,917.66
|
| Rate for Payer: Zelis Auto |
$824.80
|
| Rate for Payer: Zelis Worker's Compensation |
$562.93
|
|
|
EXCISION OF STOMACH LESION
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
CPT 43611
|
| Hospital Charge Code |
6143611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$702.98 |
| Max. Negotiated Rate |
$2,446.25 |
| Rate for Payer: Cash Price |
$1,545.00
|
| Rate for Payer: Cigna Commercial |
$2,188.75
|
| Rate for Payer: First Health Commercial |
$2,317.50
|
| Rate for Payer: First Health Workers Compensation |
$994.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,317.50
|
| Rate for Payer: GEHA Commercial |
$1,802.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,317.50
|
| Rate for Payer: Multiplan All |
$2,343.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,802.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,317.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,446.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,931.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,394.75
|
| Rate for Payer: Zelis Auto |
$1,030.00
|
| Rate for Payer: Zelis Worker's Compensation |
$702.98
|
|
|
EXCISION OF STOMACH LESION
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
CPT 43611
|
| Hospital Charge Code |
6143611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$643.75 |
| Max. Negotiated Rate |
$2,446.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,545.00
|
| Rate for Payer: Cash Price |
$1,545.00
|
| Rate for Payer: Cigna Commercial |
$2,188.75
|
| Rate for Payer: First Health Commercial |
$2,317.50
|
| Rate for Payer: First Health Workers Compensation |
$994.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,317.50
|
| Rate for Payer: GEHA Commercial |
$2,060.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,317.50
|
| Rate for Payer: Humana ChoiceCare |
$669.50
|
| Rate for Payer: Multiplan All |
$2,343.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,545.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,802.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,317.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,446.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,931.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,266.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$643.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,394.75
|
| Rate for Payer: Zelis Auto |
$1,030.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,287.50
|
| Rate for Payer: Zelis Worker's Compensation |
$702.98
|
|
|
EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL
|
Facility
|
OP
|
$2,423.61
|
|
|
Service Code
|
CPT 46320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.64 |
| 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 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 |
$1,119.58
|
| Rate for Payer: First Health Workers Compensation |
$1,440.90
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| 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 |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,018.82
|
|
|
EXCISION OF TONGUE FOLD
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
6141115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: First Health Workers Compensation |
$183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
|
EXCISION OF TONGUE FOLD
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
6141115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: First Health Workers Compensation |
$183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 41113
|
| Hospital Charge Code |
6141113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.93 |
| Max. Negotiated Rate |
$688.75 |
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$616.25
|
| Rate for Payer: First Health Commercial |
$652.50
|
| Rate for Payer: First Health Workers Compensation |
$279.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$652.50
|
| Rate for Payer: GEHA Commercial |
$507.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$652.50
|
| Rate for Payer: Multiplan All |
$659.75
|
| Rate for Payer: OMNI Networks Commercial |
$507.50
|
| Rate for Payer: One Health Plan PPO/POS |
$652.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$688.75
|
| Rate for Payer: Three Rivers Provider Network All |
$543.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$674.25
|
| Rate for Payer: Zelis Auto |
$290.00
|
| Rate for Payer: Zelis Worker's Compensation |
$197.93
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
6141110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 41113
|
| Hospital Charge Code |
6141113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.93 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$616.25
|
| Rate for Payer: First Health Commercial |
$652.50
|
| Rate for Payer: First Health Workers Compensation |
$279.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$652.50
|
| Rate for Payer: GEHA Commercial |
$580.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$652.50
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$659.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$507.50
|
| Rate for Payer: One Health Plan PPO/POS |
$652.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$688.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$543.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$674.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$290.00
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$197.93
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 41114
|
| Hospital Charge Code |
6141114
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$509.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$360.36
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 41114
|
| Hospital Charge Code |
6141114
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$509.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$1,056.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$360.36
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
6141110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
EXCISION OF TONSIL TAGS
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 42860
|
| Hospital Charge Code |
6142860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.07 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$223.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$158.07
|
|
|
EXCISION OF TONSIL TAGS
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 42860
|
| Hospital Charge Code |
6142860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.07 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$223.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$405.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Worker's Compensation |
$158.07
|
|
|
EXCISION OF UMBILICUS
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
CPT 49250
|
| Hospital Charge Code |
6149250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.43 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,177.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,041.25
|
| Rate for Payer: First Health Commercial |
$1,102.50
|
| Rate for Payer: First Health Workers Compensation |
$472.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,102.50
|
| Rate for Payer: GEHA Commercial |
$980.00
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,102.50
|
| 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 |
$2,221.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$1,114.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$857.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,102.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,565.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,221.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,163.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$918.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,221.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,139.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$490.00
|
| 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 |
$334.43
|
|
|
EXCISION OF UMBILICUS
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
CPT 49250
|
| Hospital Charge Code |
6149250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.43 |
| Max. Negotiated Rate |
$1,163.75 |
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,041.25
|
| Rate for Payer: First Health Commercial |
$1,102.50
|
| Rate for Payer: First Health Workers Compensation |
$472.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,102.50
|
| Rate for Payer: GEHA Commercial |
$857.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,102.50
|
| Rate for Payer: Multiplan All |
$1,114.75
|
| Rate for Payer: OMNI Networks Commercial |
$857.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,102.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,163.75
|
| Rate for Payer: Three Rivers Provider Network All |
$918.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,139.25
|
| Rate for Payer: Zelis Auto |
$490.00
|
| Rate for Payer: Zelis Worker's Compensation |
$334.43
|
|
|
EXCISION OF UVULA
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
6142140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$404.60
|
| Rate for Payer: First Health Commercial |
$428.40
|
| Rate for Payer: First Health Workers Compensation |
$183.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$428.40
|
| Rate for Payer: GEHA Commercial |
$333.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$428.40
|
| Rate for Payer: Multiplan All |
$433.16
|
| Rate for Payer: OMNI Networks Commercial |
$333.20
|
| Rate for Payer: One Health Plan PPO/POS |
$428.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$452.20
|
| Rate for Payer: Three Rivers Provider Network All |
$357.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$442.68
|
| Rate for Payer: Zelis Auto |
$190.40
|
| Rate for Payer: Zelis Worker's Compensation |
$129.95
|
|
|
EXCISION OF UVULA
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
6142140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$404.60
|
| Rate for Payer: First Health Commercial |
$428.40
|
| Rate for Payer: First Health Workers Compensation |
$183.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$428.40
|
| Rate for Payer: GEHA Commercial |
$380.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$428.40
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$433.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$333.20
|
| Rate for Payer: One Health Plan PPO/POS |
$428.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$452.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$357.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$442.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$190.40
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$129.95
|
|
|
EXCISION OF VAGINAL CYST OR TUMOR
|
Facility
|
OP
|
$6,038.18
|
|
|
Service Code
|
CPT 57135
|
|
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 VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL APPROACH
|
Facility
|
OP
|
$11,849.78
|
|
|
Service Code
|
CPT 55535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,560.61 |
| Max. Negotiated Rate |
$11,849.78 |
| 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 |
$5,924.89
|
| Rate for Payer: First Health Workers Compensation |
$7,625.33
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Humana ChoiceCare |
$6,517.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,924.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,953.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,924.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| 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 |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,924.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Medicare |
$5,036.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,109.87
|
| Rate for Payer: Zelis Worker's Compensation |
$5,391.65
|
|
|
EXCISION, OLECRANON BURSA
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 24105
|
|
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 OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH ALLOGRAFT
|
Facility
|
OP
|
$24,435.12
|
|
|
Service Code
|
CPT 27356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,544.86 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: First Health Workers Compensation |
$15,724.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$11,117.98
|
|
|
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: 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 |
$1,785.30
|
| 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 |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: 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 OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 27635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,544.86 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$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 |
$2,596.69
|
| 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 |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| 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 |
$2,596.69
|
| 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
|
|
