|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
6127618
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$744.80 |
| 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 |
$548.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$705.60
|
| Rate for Payer: Multiplan All |
$713.44
|
| Rate for Payer: OMNI Networks Commercial |
$548.80
|
| Rate for Payer: One Health Plan PPO/POS |
$705.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$744.80
|
| Rate for Payer: Three Rivers Provider Network All |
$588.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$729.12
|
| Rate for Payer: Zelis Auto |
$313.60
|
| Rate for Payer: Zelis Worker's Compensation |
$214.03
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 27619
|
| Hospital Charge Code |
6127619
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.35 |
| 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 Community HMO |
$576.60
|
| 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: Cash Price |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$371.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$768.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| 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: Multiplan All |
$874.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| 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 Commercial |
$912.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| 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: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$384.40
|
| 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 |
$262.35
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 27619
|
| Hospital Charge Code |
6127619
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.35 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$371.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$672.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.95
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Worker's Compensation |
$262.35
|
|
|
EXC LEG/ANKLE TUM DEP 5 CM/>
|
Facility
|
IP
|
$1,989.60
|
|
|
Service Code
|
CPT 27634
|
| Hospital Charge Code |
6127634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.16 |
| Max. Negotiated Rate |
$1,890.12 |
| Rate for Payer: Cash Price |
$1,193.76
|
| Rate for Payer: Cigna Commercial |
$1,691.16
|
| Rate for Payer: First Health Commercial |
$1,790.64
|
| Rate for Payer: First Health Workers Compensation |
$768.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.64
|
| Rate for Payer: GEHA Commercial |
$1,392.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.64
|
| Rate for Payer: Multiplan All |
$1,810.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.72
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,890.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,492.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,850.33
|
| Rate for Payer: Zelis Auto |
$795.84
|
| Rate for Payer: Zelis Worker's Compensation |
$543.16
|
|
|
EXC LEG/ANKLE TUM DEP 5 CM/>
|
Facility
|
OP
|
$1,989.60
|
|
|
Service Code
|
CPT 27634
|
| Hospital Charge Code |
6127634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.16 |
| 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 |
$1,193.76
|
| 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 |
$1,193.76
|
| Rate for Payer: Cash Price |
$1,193.76
|
| Rate for Payer: Cigna Commercial |
$1,691.16
|
| Rate for Payer: First Health Commercial |
$1,790.64
|
| Rate for Payer: First Health Workers Compensation |
$768.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.64
|
| Rate for Payer: GEHA Commercial |
$1,591.68
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.64
|
| 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 |
$1,810.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.72
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.64
|
| 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 |
$1,890.12
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,492.20
|
| 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 |
$1,850.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$795.84
|
| 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 |
$543.16
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
6126160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$323.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$228.50
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
8226160
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,017.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,356.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
8226160
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$1,610.25 |
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,186.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
8826160
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,017.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,356.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
8826160
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$1,610.25 |
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,186.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
6126160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$323.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$669.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$228.50
|
|
|
EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRD
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
9441112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.37 |
| 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 |
$609.60
|
| 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 |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$863.60
|
| Rate for Payer: First Health Commercial |
$914.40
|
| Rate for Payer: First Health Workers Compensation |
$392.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$914.40
|
| Rate for Payer: GEHA Commercial |
$812.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$914.40
|
| 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 |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$924.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$711.20
|
| Rate for Payer: One Health Plan PPO/POS |
$914.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$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 |
$965.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$762.00
|
| 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 |
$944.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$406.40
|
| 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 |
$277.37
|
|
|
EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRD
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
9441112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$965.20 |
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$863.60
|
| Rate for Payer: First Health Commercial |
$914.40
|
| Rate for Payer: First Health Workers Compensation |
$392.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$914.40
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$914.40
|
| Rate for Payer: Multiplan All |
$924.56
|
| Rate for Payer: OMNI Networks Commercial |
$711.20
|
| Rate for Payer: One Health Plan PPO/POS |
$914.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$965.20
|
| Rate for Payer: Three Rivers Provider Network All |
$762.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$944.88
|
| Rate for Payer: Zelis Auto |
$406.40
|
| Rate for Payer: Zelis Worker's Compensation |
$277.37
|
|
|
EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRD
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
6141112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$539.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$731.50
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.10
|
| Rate for Payer: Zelis Auto |
$308.00
|
| Rate for Payer: Zelis Worker's Compensation |
$210.21
|
|
|
EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRD
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
6141112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$210.21 |
| 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 |
$462.00
|
| 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 |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$616.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| 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 |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| 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 |
$731.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| 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 |
$716.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$308.00
|
| 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 |
$210.21
|
|
|
EXC MALIGNANT LESION F/E/E/N/L 0.6-1.0CM
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
8511641
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$322.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
EXC MALIGNANT LESION F/E/E/N/L 0.6-1.0CM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
8511641
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$276.00
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$368.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
EXC MALIGNANT LESION F/E/E/N/L 0.6-1.0CM
|
Facility
|
IP
|
$653.01
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
7211641
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$178.27 |
| Max. Negotiated Rate |
$620.36 |
| Rate for Payer: Cash Price |
$391.81
|
| Rate for Payer: Cigna Commercial |
$555.06
|
| Rate for Payer: First Health Commercial |
$587.71
|
| Rate for Payer: First Health Workers Compensation |
$252.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$587.71
|
| Rate for Payer: GEHA Commercial |
$457.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$587.71
|
| Rate for Payer: Multiplan All |
$594.24
|
| Rate for Payer: OMNI Networks Commercial |
$457.11
|
| Rate for Payer: One Health Plan PPO/POS |
$587.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$620.36
|
| Rate for Payer: Three Rivers Provider Network All |
$489.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$607.30
|
| Rate for Payer: Zelis Auto |
$261.20
|
| Rate for Payer: Zelis Worker's Compensation |
$178.27
|
|
|
EXC MALIGNANT LESION F/E/E/N/L 0.6-1.0CM
|
Facility
|
OP
|
$653.01
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
7211641
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$178.27 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$391.81
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$391.81
|
| Rate for Payer: Cash Price |
$391.81
|
| Rate for Payer: Cigna Commercial |
$555.06
|
| Rate for Payer: First Health Commercial |
$587.71
|
| Rate for Payer: First Health Workers Compensation |
$252.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$587.71
|
| Rate for Payer: GEHA Commercial |
$522.41
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$587.71
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$594.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$457.11
|
| Rate for Payer: One Health Plan PPO/POS |
$587.71
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$620.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$489.76
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$607.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$261.20
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$178.27
|
|
|
EXC MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
20311601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
EXC MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
20311601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
EXC NECK LES SC < 3 CM
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
6121555
|
|
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
|
|
|
EXC NECK LES SC < 3 CM
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
6121555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$744.80 |
| 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 |
$548.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$705.60
|
| Rate for Payer: Multiplan All |
$713.44
|
| Rate for Payer: OMNI Networks Commercial |
$548.80
|
| Rate for Payer: One Health Plan PPO/POS |
$705.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$744.80
|
| Rate for Payer: Three Rivers Provider Network All |
$588.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$729.12
|
| Rate for Payer: Zelis Auto |
$313.60
|
| Rate for Payer: Zelis Worker's Compensation |
$214.03
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
6121552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| 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 |
$555.60
|
| 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 |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$740.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| 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 |
$842.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| 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 |
$879.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| 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 |
$861.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$370.40
|
| 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 |
$252.80
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
6121552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$648.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Worker's Compensation |
$252.80
|
|
