|
EXC NECK TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
6121556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.39 |
| Max. Negotiated Rate |
$1,038.35 |
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: First Health Commercial |
$983.70
|
| Rate for Payer: First Health Workers Compensation |
$422.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$983.70
|
| Rate for Payer: GEHA Commercial |
$765.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$983.70
|
| Rate for Payer: Multiplan All |
$994.63
|
| Rate for Payer: OMNI Networks Commercial |
$765.10
|
| Rate for Payer: One Health Plan PPO/POS |
$983.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,038.35
|
| Rate for Payer: Three Rivers Provider Network All |
$819.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,016.49
|
| Rate for Payer: Zelis Auto |
$437.20
|
| Rate for Payer: Zelis Worker's Compensation |
$298.39
|
|
|
EXC NECK TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
6121556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.39 |
| 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 |
$655.80
|
| 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 |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: First Health Commercial |
$983.70
|
| Rate for Payer: First Health Workers Compensation |
$422.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$983.70
|
| Rate for Payer: GEHA Commercial |
$874.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$983.70
|
| 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 |
$994.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$765.10
|
| Rate for Payer: One Health Plan PPO/POS |
$983.70
|
| 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 |
$1,038.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$819.75
|
| 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 |
$1,016.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$437.20
|
| 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 |
$298.39
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
6121554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| 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 |
$911.40
|
| 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 |
$911.40
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,215.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| 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 |
$1,382.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| 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 |
$1,443.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| 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 |
$1,412.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$607.60
|
| 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 |
$414.69
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
6121554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,063.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| Rate for Payer: Multiplan All |
$1,382.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,443.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,412.67
|
| Rate for Payer: Zelis Auto |
$607.60
|
| Rate for Payer: Zelis Worker's Compensation |
$414.69
|
|
|
EXC RECT TUM TRANSANAL FULL
|
Facility
|
OP
|
$1,674.00
|
|
|
Service Code
|
CPT 45172
|
| Hospital Charge Code |
6145172
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$457.00 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,004.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna Commercial |
$1,422.90
|
| Rate for Payer: First Health Commercial |
$1,506.60
|
| Rate for Payer: First Health Workers Compensation |
$646.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,506.60
|
| Rate for Payer: GEHA Commercial |
$1,339.20
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,506.60
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,523.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,506.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,590.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$1,255.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,556.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$669.60
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$457.00
|
|
|
EXC RECT TUM TRANSANAL FULL
|
Facility
|
IP
|
$1,674.00
|
|
|
Service Code
|
CPT 45172
|
| Hospital Charge Code |
6145172
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$457.00 |
| Max. Negotiated Rate |
$1,590.30 |
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna Commercial |
$1,422.90
|
| Rate for Payer: First Health Commercial |
$1,506.60
|
| Rate for Payer: First Health Workers Compensation |
$646.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,506.60
|
| Rate for Payer: GEHA Commercial |
$1,171.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,506.60
|
| Rate for Payer: Multiplan All |
$1,523.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,506.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,590.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,255.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,556.82
|
| Rate for Payer: Zelis Auto |
$669.60
|
| Rate for Payer: Zelis Worker's Compensation |
$457.00
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
6145171
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.97 |
| Max. Negotiated Rate |
$1,176.10 |
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$1,052.30
|
| Rate for Payer: First Health Commercial |
$1,114.20
|
| Rate for Payer: First Health Workers Compensation |
$477.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,114.20
|
| Rate for Payer: GEHA Commercial |
$866.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,114.20
|
| Rate for Payer: Multiplan All |
$1,126.58
|
| Rate for Payer: OMNI Networks Commercial |
$866.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,114.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,176.10
|
| Rate for Payer: Three Rivers Provider Network All |
$928.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,151.34
|
| Rate for Payer: Zelis Auto |
$495.20
|
| Rate for Payer: Zelis Worker's Compensation |
$337.97
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
6145171
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.97 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$742.80
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$1,052.30
|
| Rate for Payer: First Health Commercial |
$1,114.20
|
| Rate for Payer: First Health Workers Compensation |
$477.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,114.20
|
| Rate for Payer: GEHA Commercial |
$990.40
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,114.20
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,126.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$866.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,114.20
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,176.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$928.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,151.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$495.20
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$337.97
|
|
|
EXC SHOULDER LES SC < 3 CM
|
Facility
|
IP
|
$1,421.70
|
|
|
Service Code
|
CPT 23075
|
| Hospital Charge Code |
6123075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.12 |
| Max. Negotiated Rate |
$1,350.62 |
| Rate for Payer: Cash Price |
$853.02
|
| Rate for Payer: Cigna Commercial |
$1,208.44
|
| Rate for Payer: First Health Commercial |
$1,279.53
|
| Rate for Payer: First Health Workers Compensation |
$548.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.53
|
| Rate for Payer: GEHA Commercial |
$995.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.53
|
| Rate for Payer: Multiplan All |
$1,293.75
|
| Rate for Payer: OMNI Networks Commercial |
$995.19
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.62
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.18
|
| Rate for Payer: Zelis Auto |
$568.68
|
| Rate for Payer: Zelis Worker's Compensation |
$388.12
|
|
|
EXC SHOULDER LES SC < 3 CM
|
Facility
|
OP
|
$1,421.70
|
|
|
Service Code
|
CPT 23075
|
| Hospital Charge Code |
6123075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.12 |
| 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 |
$853.02
|
| 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 |
$853.02
|
| Rate for Payer: Cash Price |
$853.02
|
| Rate for Payer: Cigna Commercial |
$1,208.44
|
| Rate for Payer: First Health Commercial |
$1,279.53
|
| Rate for Payer: First Health Workers Compensation |
$548.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.53
|
| Rate for Payer: GEHA Commercial |
$1,137.36
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.53
|
| 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 |
$1,293.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$995.19
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.53
|
| 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 |
$1,350.62
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.28
|
| 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 |
$1,322.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$568.68
|
| 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 |
$388.12
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
6123071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| 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 Community HMO |
$520.20
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$693.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| 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: Multiplan All |
$788.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| 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 Commercial |
$823.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| 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: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$346.80
|
| 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 |
$236.69
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
6123071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$823.65 |
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$606.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
EXC SHOULDER TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
CPT 23076
|
| Hospital Charge Code |
6123076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$303.30 |
| 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 |
$666.60
|
| 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 |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$944.35
|
| Rate for Payer: First Health Commercial |
$999.90
|
| Rate for Payer: First Health Workers Compensation |
$428.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$999.90
|
| Rate for Payer: GEHA Commercial |
$888.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$999.90
|
| 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 |
$1,011.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$777.70
|
| Rate for Payer: One Health Plan PPO/POS |
$999.90
|
| 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 |
$1,055.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$833.25
|
| 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 |
$1,033.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$444.40
|
| 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 |
$303.30
|
|
|
EXC SHOULDER TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
CPT 23076
|
| Hospital Charge Code |
6123076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$303.30 |
| Max. Negotiated Rate |
$1,055.45 |
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$944.35
|
| Rate for Payer: First Health Commercial |
$999.90
|
| Rate for Payer: First Health Workers Compensation |
$428.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$999.90
|
| Rate for Payer: GEHA Commercial |
$777.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$999.90
|
| Rate for Payer: Multiplan All |
$1,011.01
|
| Rate for Payer: OMNI Networks Commercial |
$777.70
|
| Rate for Payer: One Health Plan PPO/POS |
$999.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,055.45
|
| Rate for Payer: Three Rivers Provider Network All |
$833.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,033.23
|
| Rate for Payer: Zelis Auto |
$444.40
|
| Rate for Payer: Zelis Worker's Compensation |
$303.30
|
|
|
EXC SHOULDER TUM DEEP 5 CM/>
|
Facility
|
IP
|
$1,434.00
|
|
|
Service Code
|
CPT 23073
|
| Hospital Charge Code |
6123073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.48 |
| Max. Negotiated Rate |
$1,362.30 |
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$1,218.90
|
| Rate for Payer: First Health Commercial |
$1,290.60
|
| Rate for Payer: First Health Workers Compensation |
$553.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,290.60
|
| Rate for Payer: GEHA Commercial |
$1,003.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,290.60
|
| Rate for Payer: Multiplan All |
$1,304.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,290.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,362.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,075.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,333.62
|
| Rate for Payer: Zelis Auto |
$573.60
|
| Rate for Payer: Zelis Worker's Compensation |
$391.48
|
|
|
EXC SHOULDER TUM DEEP 5 CM/>
|
Facility
|
OP
|
$1,434.00
|
|
|
Service Code
|
CPT 23073
|
| Hospital Charge Code |
6123073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.48 |
| 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 |
$860.40
|
| 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 |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$1,218.90
|
| Rate for Payer: First Health Commercial |
$1,290.60
|
| Rate for Payer: First Health Workers Compensation |
$553.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,290.60
|
| Rate for Payer: GEHA Commercial |
$1,147.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,290.60
|
| 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 |
$1,304.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,290.60
|
| 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 |
$1,362.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,075.50
|
| 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 |
$1,333.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$573.60
|
| 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 |
$391.48
|
|
|
EXCSN MALIG LESION S/N/H/F/G 1.1-2.0CM
|
Facility
|
OP
|
$5,771.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
1911622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.88 |
| Max. Negotiated Rate |
$5,482.45 |
| 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 |
$3,462.60
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$3,462.60
|
| Rate for Payer: Cash Price |
$3,462.60
|
| Rate for Payer: Cigna Commercial |
$4,905.35
|
| Rate for Payer: First Health Commercial |
$5,193.90
|
| Rate for Payer: First Health Workers Compensation |
$2,228.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,193.90
|
| Rate for Payer: GEHA Commercial |
$4,616.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,193.90
|
| 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 |
$5,251.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$4,039.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,193.90
|
| 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 |
$5,482.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$4,328.25
|
| 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 |
$5,367.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$2,308.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$1,575.48
|
|
|
EXCSN MALIG LESION S/N/H/F/G 1.1-2.0CM
|
Facility
|
IP
|
$5,771.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
1911622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,575.48 |
| Max. Negotiated Rate |
$5,482.45 |
| Rate for Payer: Cash Price |
$3,462.60
|
| Rate for Payer: Cigna Commercial |
$4,905.35
|
| Rate for Payer: First Health Commercial |
$5,193.90
|
| Rate for Payer: First Health Workers Compensation |
$2,228.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,193.90
|
| Rate for Payer: GEHA Commercial |
$4,039.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,193.90
|
| Rate for Payer: Multiplan All |
$5,251.61
|
| Rate for Payer: OMNI Networks Commercial |
$4,039.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,193.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,482.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,328.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,367.03
|
| Rate for Payer: Zelis Auto |
$2,308.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,575.48
|
|
|
EXCSN MALIGNANT LSN F/E/E/N/L 1.1-2.0CM
|
Facility
|
IP
|
$6,962.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
20311642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,900.63 |
| Max. Negotiated Rate |
$6,613.90 |
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cigna Commercial |
$5,917.70
|
| Rate for Payer: First Health Commercial |
$6,265.80
|
| Rate for Payer: First Health Workers Compensation |
$2,688.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,265.80
|
| Rate for Payer: GEHA Commercial |
$4,873.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,265.80
|
| Rate for Payer: Multiplan All |
$6,335.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,873.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,265.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,613.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,221.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,474.66
|
| Rate for Payer: Zelis Auto |
$2,784.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,900.63
|
|
|
EXCSN MALIGNANT LSN F/E/E/N/L 1.1-2.0CM
|
Facility
|
OP
|
$6,962.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
20311642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$567.88 |
| Max. Negotiated Rate |
$6,613.90 |
| 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 |
$4,177.20
|
| 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 |
$4,177.20
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cigna Commercial |
$5,917.70
|
| Rate for Payer: First Health Commercial |
$6,265.80
|
| Rate for Payer: First Health Workers Compensation |
$2,688.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,265.80
|
| Rate for Payer: GEHA Commercial |
$5,569.60
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,265.80
|
| 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 |
$6,335.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$4,873.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,265.80
|
| 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 |
$6,613.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$5,221.50
|
| 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 |
$6,474.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$2,784.80
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$1,900.63
|
|
|
EXC SUBLINGUAL SALIVARY CYST RANULA
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT 42408
|
| Hospital Charge Code |
6142408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.38 |
| 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 |
$825.00
|
| 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 |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,168.75
|
| Rate for Payer: First Health Commercial |
$1,237.50
|
| Rate for Payer: First Health Workers Compensation |
$530.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,237.50
|
| Rate for Payer: GEHA Commercial |
$1,100.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,237.50
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,251.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$962.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,237.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,306.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,031.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,278.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$550.00
|
| 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 |
$375.38
|
|
|
EXC SUBLINGUAL SALIVARY CYST RANULA
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT 42408
|
| Hospital Charge Code |
6142408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.38 |
| Max. Negotiated Rate |
$1,306.25 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,168.75
|
| Rate for Payer: First Health Commercial |
$1,237.50
|
| Rate for Payer: First Health Workers Compensation |
$530.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,237.50
|
| Rate for Payer: GEHA Commercial |
$962.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,237.50
|
| Rate for Payer: Multiplan All |
$1,251.25
|
| Rate for Payer: OMNI Networks Commercial |
$962.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,237.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,306.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,031.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,278.75
|
| Rate for Payer: Zelis Auto |
$550.00
|
| Rate for Payer: Zelis Worker's Compensation |
$375.38
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
6127327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$219.22 |
| 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 Community HMO |
$481.80
|
| 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: Cash Price |
$481.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$682.55
|
| Rate for Payer: First Health Commercial |
$722.70
|
| Rate for Payer: First Health Workers Compensation |
$310.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$722.70
|
| Rate for Payer: GEHA Commercial |
$642.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.70
|
| 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: Multiplan All |
$730.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$562.10
|
| Rate for Payer: One Health Plan PPO/POS |
$722.70
|
| 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 Commercial |
$762.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$602.25
|
| 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: United Payors & United Providers UP&UP |
$746.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$321.20
|
| 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 |
$219.22
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
6127327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$219.22 |
| Max. Negotiated Rate |
$762.85 |
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$682.55
|
| Rate for Payer: First Health Commercial |
$722.70
|
| Rate for Payer: First Health Workers Compensation |
$310.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$722.70
|
| Rate for Payer: GEHA Commercial |
$562.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.70
|
| Rate for Payer: Multiplan All |
$730.73
|
| Rate for Payer: OMNI Networks Commercial |
$562.10
|
| Rate for Payer: One Health Plan PPO/POS |
$722.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$762.85
|
| Rate for Payer: Three Rivers Provider Network All |
$602.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$746.79
|
| Rate for Payer: Zelis Auto |
$321.20
|
| Rate for Payer: Zelis Worker's Compensation |
$219.22
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
6127337
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| 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 |
$519.00
|
| 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 |
$519.00
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$692.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| 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 |
$787.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| 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 |
$821.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| 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 |
$804.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$346.00
|
| 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 |
$236.15
|
|
