|
EXCISION OR FULGURATION; SKENE'S GLANDS
|
Facility
|
OP
|
$6,549.86
|
|
|
Service Code
|
CPT 53270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,628.99 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: First Health Workers Compensation |
$4,214.83
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$2,980.19
|
|
|
EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
6111770
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$493.00
|
| Rate for Payer: First Health Commercial |
$522.00
|
| Rate for Payer: First Health Workers Compensation |
$223.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.00
|
| Rate for Payer: GEHA Commercial |
$406.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.00
|
| Rate for Payer: Multiplan All |
$527.80
|
| Rate for Payer: OMNI Networks Commercial |
$406.00
|
| Rate for Payer: One Health Plan PPO/POS |
$522.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.00
|
| Rate for Payer: Three Rivers Provider Network All |
$435.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$539.40
|
| Rate for Payer: Zelis Auto |
$232.00
|
| Rate for Payer: Zelis Worker's Compensation |
$158.34
|
|
|
EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
20300052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.33 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 Community HMO |
$517.20
|
| 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 |
$2,717.63
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$732.70
|
| Rate for Payer: First Health Commercial |
$775.80
|
| Rate for Payer: First Health Workers Compensation |
$332.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$775.80
|
| Rate for Payer: GEHA Commercial |
$689.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$775.80
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$784.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$603.40
|
| Rate for Payer: One Health Plan PPO/POS |
$775.80
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$818.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$646.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$801.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$344.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$235.33
|
|
|
EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
6111770
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 Community HMO |
$348.00
|
| 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 |
$2,717.63
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$493.00
|
| Rate for Payer: First Health Commercial |
$522.00
|
| Rate for Payer: First Health Workers Compensation |
$223.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.00
|
| Rate for Payer: GEHA Commercial |
$464.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.00
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$527.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$406.00
|
| Rate for Payer: One Health Plan PPO/POS |
$522.00
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$435.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$539.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$232.00
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$158.34
|
|
|
EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
20300052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.33 |
| Max. Negotiated Rate |
$818.90 |
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$732.70
|
| Rate for Payer: First Health Commercial |
$775.80
|
| Rate for Payer: First Health Workers Compensation |
$332.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$775.80
|
| Rate for Payer: GEHA Commercial |
$603.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$775.80
|
| Rate for Payer: Multiplan All |
$784.42
|
| Rate for Payer: OMNI Networks Commercial |
$603.40
|
| Rate for Payer: One Health Plan PPO/POS |
$775.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$818.90
|
| Rate for Payer: Three Rivers Provider Network All |
$646.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$801.66
|
| Rate for Payer: Zelis Auto |
$344.80
|
| Rate for Payer: Zelis Worker's Compensation |
$235.33
|
|
|
EXCISION SINGLE EXTERNAL PAPILLA OR TAG
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
20346220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$140.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$292.00
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| 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 |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$146.00
|
| 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 |
$99.64
|
|
|
EXCISION SINGLE EXTERNAL PAPILLA OR TAG
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
20346220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$140.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$255.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$99.64
|
|
|
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER
|
Facility
|
OP
|
$3,076.96
|
|
|
Service Code
|
CPT 26111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$1,538.48
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; LESS THAN 1.5 CM
|
Facility
|
OP
|
$3,076.96
|
|
|
Service Code
|
CPT 26115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
EXCISION TUMOR SOFT TISS F/S SUBQ 2CM/>
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 21012
|
| Hospital Charge Code |
9421012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$844.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$422.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$288.29
|
|
|
EXCISION TUMOR SOFT TISS F/S SUBQ 2CM/>
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 21012
|
| Hospital Charge Code |
6121012
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$844.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$422.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$288.29
|
|
|
EXCISION TUMOR SOFT TISS F/S SUBQ 2CM/>
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 21012
|
| Hospital Charge Code |
9421012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$1,003.20 |
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: Zelis Auto |
$422.40
|
| Rate for Payer: Zelis Worker's Compensation |
$288.29
|
|
|
EXCISION TUMOR SOFT TISS F/S SUBQ 2CM/>
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 21012
|
| Hospital Charge Code |
20321012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$1,003.20 |
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: Zelis Auto |
$422.40
|
| Rate for Payer: Zelis Worker's Compensation |
$288.29
|
|
|
EXCISION TUMOR SOFT TISS F/S SUBQ 2CM/>
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 21012
|
| Hospital Charge Code |
6121012
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$1,003.20 |
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: Zelis Auto |
$422.40
|
| Rate for Payer: Zelis Worker's Compensation |
$288.29
|
|
|
EXCISION TUMOR SOFT TISS F/S SUBQ 2CM/>
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 21012
|
| Hospital Charge Code |
20321012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$844.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$422.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$288.29
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$5,435.26
|
|
|
Service Code
|
CPT 22901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.34 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 |
$2,717.63
|
| Rate for Payer: First Health Workers Compensation |
$3,497.59
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$2,473.04
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$5,435.26
|
|
|
Service Code
|
CPT 27632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.34 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 |
$2,717.63
|
| Rate for Payer: First Health Workers Compensation |
$3,497.59
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$2,473.04
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$5,435.26
|
|
|
Service Code
|
CPT 27634
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.34 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 |
$2,717.63
|
| Rate for Payer: First Health Workers Compensation |
$3,497.59
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$2,473.04
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$5,435.26
|
|
|
Service Code
|
CPT 27619
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,401.53 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: First Health Workers Compensation |
$3,497.59
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$2,473.04
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$3,076.96
|
|
|
Service Code
|
CPT 23075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
EXCIS UPPR JAW CYST W/REPAIR
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
CPT 21049
|
| Hospital Charge Code |
6121049
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$685.50 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,506.60
|
| 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 |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,506.60
|
| Rate for Payer: Cigna Commercial |
$2,134.35
|
| Rate for Payer: First Health Commercial |
$2,259.90
|
| Rate for Payer: First Health Workers Compensation |
$969.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,259.90
|
| Rate for Payer: GEHA Commercial |
$2,008.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,259.90
|
| 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 |
$2,285.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,757.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,259.90
|
| 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 |
$2,385.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,883.25
|
| 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 |
$2,335.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,004.40
|
| 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 |
$685.50
|
|
|
EXCIS UPPR JAW CYST W/REPAIR
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
CPT 21049
|
| Hospital Charge Code |
6121049
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$685.50 |
| Max. Negotiated Rate |
$2,385.45 |
| Rate for Payer: Cash Price |
$1,506.60
|
| Rate for Payer: Cigna Commercial |
$2,134.35
|
| Rate for Payer: First Health Commercial |
$2,259.90
|
| Rate for Payer: First Health Workers Compensation |
$969.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,259.90
|
| Rate for Payer: GEHA Commercial |
$1,757.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,259.90
|
| Rate for Payer: Multiplan All |
$2,285.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,757.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,259.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,385.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,883.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,335.23
|
| Rate for Payer: Zelis Auto |
$1,004.40
|
| Rate for Payer: Zelis Worker's Compensation |
$685.50
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>
|
Facility
|
OP
|
$1,223.19
|
|
|
Service Code
|
CPT 27632
|
| Hospital Charge Code |
6127632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.93 |
| Max. Negotiated Rate |
$5,435.26 |
| 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 Community HMO |
$733.91
|
| 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 |
$2,717.63
|
| Rate for Payer: Cash Price |
$733.91
|
| Rate for Payer: Cash Price |
$733.91
|
| Rate for Payer: Cigna Commercial |
$1,039.71
|
| Rate for Payer: First Health Commercial |
$1,100.87
|
| Rate for Payer: First Health Workers Compensation |
$472.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.87
|
| Rate for Payer: GEHA Commercial |
$978.55
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.87
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,113.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$856.23
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.87
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,162.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$917.39
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$489.28
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$333.93
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>
|
Facility
|
IP
|
$1,223.19
|
|
|
Service Code
|
CPT 27632
|
| Hospital Charge Code |
6127632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.93 |
| Max. Negotiated Rate |
$1,162.03 |
| Rate for Payer: Cash Price |
$733.91
|
| Rate for Payer: Cigna Commercial |
$1,039.71
|
| Rate for Payer: First Health Commercial |
$1,100.87
|
| Rate for Payer: First Health Workers Compensation |
$472.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.87
|
| Rate for Payer: GEHA Commercial |
$856.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.87
|
| Rate for Payer: Multiplan All |
$1,113.10
|
| Rate for Payer: OMNI Networks Commercial |
$856.23
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,162.03
|
| Rate for Payer: Three Rivers Provider Network All |
$917.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.57
|
| Rate for Payer: Zelis Auto |
$489.28
|
| Rate for Payer: Zelis Worker's Compensation |
$333.93
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
6127618
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cigna Commercial |
$666.40
|
| Rate for Payer: First Health Commercial |
$705.60
|
| Rate for Payer: First Health Workers Compensation |
$302.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$705.60
|
| Rate for Payer: GEHA Commercial |
$627.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$705.60
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$713.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$548.80
|
| Rate for Payer: One Health Plan PPO/POS |
$705.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$744.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$588.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$729.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$313.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$214.03
|
|
