|
LARYNGOSCOPY W/FB REMOVAL
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
6131530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.14 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: First Health Workers Compensation |
$199.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$413.60
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$141.14
|
|
|
LARYNGOSCOPY W/FB REMOVAL
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
6131530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.14 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: First Health Workers Compensation |
$199.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$361.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Worker's Compensation |
$141.14
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
6131576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
6131576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$307.20
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT 31510
|
| Hospital Charge Code |
6131510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$102.92 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$226.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$320.45
|
| Rate for Payer: First Health Commercial |
$339.30
|
| Rate for Payer: First Health Workers Compensation |
$145.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$339.30
|
| Rate for Payer: GEHA Commercial |
$301.60
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$339.30
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$343.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$263.90
|
| Rate for Payer: One Health Plan PPO/POS |
$339.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$358.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$282.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$350.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$150.80
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$102.92
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT 31510
|
| Hospital Charge Code |
6131510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$102.92 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$320.45
|
| Rate for Payer: First Health Commercial |
$339.30
|
| Rate for Payer: First Health Workers Compensation |
$145.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$339.30
|
| Rate for Payer: GEHA Commercial |
$263.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$339.30
|
| Rate for Payer: Multiplan All |
$343.07
|
| Rate for Payer: OMNI Networks Commercial |
$263.90
|
| Rate for Payer: One Health Plan PPO/POS |
$339.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$358.15
|
| Rate for Payer: Three Rivers Provider Network All |
$282.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$350.61
|
| Rate for Payer: Zelis Auto |
$150.80
|
| Rate for Payer: Zelis Worker's Compensation |
$102.92
|
|
|
LARYNGPLSTY LARYN STEN W INDW =/> 12YRS
|
Facility
|
IP
|
$6,287.00
|
|
|
Service Code
|
CPT 31554
|
| Hospital Charge Code |
6191080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$5,972.65 |
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$4,400.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGPLSTY LARYN STEN W INDW =/> 12YRS
|
Facility
|
OP
|
$6,287.00
|
|
|
Service Code
|
CPT 31554
|
| Hospital Charge Code |
6191080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,772.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,906.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$5,029.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,006.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,780.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,006.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,006.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGPLSTY LARYN STEN W INDWELL <12YRS
|
Facility
|
IP
|
$6,287.00
|
|
|
Service Code
|
CPT 31553
|
| Hospital Charge Code |
6191079
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$5,972.65 |
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$4,400.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGPLSTY LARYN STEN W INDWELL <12YRS
|
Facility
|
OP
|
$6,287.00
|
|
|
Service Code
|
CPT 31553
|
| Hospital Charge Code |
6191079
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,772.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,906.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$5,029.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,006.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,780.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,006.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,006.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGPLSTY LARYN STEN WO INDW =/> 12YRS
|
Facility
|
IP
|
$6,287.00
|
|
|
Service Code
|
CPT 31552
|
| Hospital Charge Code |
6191078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$5,972.65 |
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$4,400.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGPLSTY LARYN STEN WO INDW =/> 12YRS
|
Facility
|
OP
|
$6,287.00
|
|
|
Service Code
|
CPT 31552
|
| Hospital Charge Code |
6191078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,772.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,906.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$5,029.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,006.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,780.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,006.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,006.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGPLSTY LARYN STEN WO INDWELL <12YRS
|
Facility
|
IP
|
$6,287.00
|
|
|
Service Code
|
CPT 31551
|
| Hospital Charge Code |
6191077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$5,972.65 |
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$4,400.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNGPLSTY LARYN STEN WO INDWELL <12YRS
|
Facility
|
OP
|
$6,287.00
|
|
|
Service Code
|
CPT 31551
|
| Hospital Charge Code |
6191077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,716.35 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,772.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,906.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cash Price |
$3,772.20
|
| Rate for Payer: Cigna Commercial |
$5,343.95
|
| Rate for Payer: First Health Commercial |
$5,658.30
|
| Rate for Payer: First Health Workers Compensation |
$2,427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,658.30
|
| Rate for Payer: GEHA Commercial |
$5,029.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,658.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,006.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$5,721.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,400.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,658.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,780.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,006.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,972.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,715.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,006.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,846.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$2,514.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$1,716.35
|
|
|
LARYNSCOP REMVE CART + SCOP
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
CPT 31561
|
| Hospital Charge Code |
6131561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$244.88 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: First Health Workers Compensation |
$346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$717.60
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$358.80
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$244.88
|
|
|
LARYNSCOP REMVE CART + SCOP
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
CPT 31561
|
| Hospital Charge Code |
6131561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$244.88 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: First Health Workers Compensation |
$346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$627.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: Zelis Auto |
$358.80
|
| Rate for Payer: Zelis Worker's Compensation |
$244.88
|
|
|
LARYNSCOP W/TUMR EXC + SCOPE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
6131541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$413.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cigna Commercial |
$585.65
|
| Rate for Payer: First Health Commercial |
$620.10
|
| Rate for Payer: First Health Workers Compensation |
$266.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.10
|
| Rate for Payer: GEHA Commercial |
$551.20
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.10
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$626.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$482.30
|
| Rate for Payer: One Health Plan PPO/POS |
$620.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$654.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$516.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$640.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$275.60
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$188.10
|
|
|
LARYNSCOP W/TUMR EXC + SCOPE
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
6131541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$654.55 |
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cigna Commercial |
$585.65
|
| Rate for Payer: First Health Commercial |
$620.10
|
| Rate for Payer: First Health Workers Compensation |
$266.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.10
|
| Rate for Payer: GEHA Commercial |
$482.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.10
|
| Rate for Payer: Multiplan All |
$626.99
|
| Rate for Payer: OMNI Networks Commercial |
$482.30
|
| Rate for Payer: One Health Plan PPO/POS |
$620.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$654.55
|
| Rate for Payer: Three Rivers Provider Network All |
$516.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$640.77
|
| Rate for Payer: Zelis Auto |
$275.60
|
| Rate for Payer: Zelis Worker's Compensation |
$188.10
|
|
|
LASER SURGERY ANAL LESIONS
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 46917
|
| Hospital Charge Code |
6146917
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$241.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$342.55
|
| Rate for Payer: First Health Commercial |
$362.70
|
| Rate for Payer: First Health Workers Compensation |
$155.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$362.70
|
| Rate for Payer: GEHA Commercial |
$322.40
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$362.70
|
| 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 |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$366.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$282.10
|
| Rate for Payer: One Health Plan PPO/POS |
$362.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$382.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$302.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$374.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$161.20
|
| 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 |
$110.02
|
|
|
LASER SURGERY ANAL LESIONS
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 46917
|
| Hospital Charge Code |
6146917
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$382.85 |
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$342.55
|
| Rate for Payer: First Health Commercial |
$362.70
|
| Rate for Payer: First Health Workers Compensation |
$155.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$362.70
|
| Rate for Payer: GEHA Commercial |
$282.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$362.70
|
| Rate for Payer: Multiplan All |
$366.73
|
| Rate for Payer: OMNI Networks Commercial |
$282.10
|
| Rate for Payer: One Health Plan PPO/POS |
$362.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$382.85
|
| Rate for Payer: Three Rivers Provider Network All |
$302.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$374.79
|
| Rate for Payer: Zelis Auto |
$161.20
|
| Rate for Payer: Zelis Worker's Compensation |
$110.02
|
|
|
LASER SURGERY OF CERVIX
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 57513
|
| Hospital Charge Code |
6157513
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
LASER SURGERY OF CERVIX
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 57513
|
| Hospital Charge Code |
6157513
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
LASER SURGERY OF PROSTATE
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
CPT 52647
|
| Hospital Charge Code |
6152647
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$556.10 |
| Max. Negotiated Rate |
$1,935.15 |
| Rate for Payer: Cash Price |
$1,222.20
|
| Rate for Payer: Cigna Commercial |
$1,731.45
|
| Rate for Payer: First Health Commercial |
$1,833.30
|
| Rate for Payer: First Health Workers Compensation |
$786.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,833.30
|
| Rate for Payer: GEHA Commercial |
$1,425.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,833.30
|
| Rate for Payer: Multiplan All |
$1,853.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,425.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,833.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,935.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,527.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,894.41
|
| Rate for Payer: Zelis Auto |
$814.80
|
| Rate for Payer: Zelis Worker's Compensation |
$556.10
|
|
|
LASER SURGERY OF PROSTATE
|
Facility
|
OP
|
$2,037.00
|
|
|
Service Code
|
CPT 52647
|
| Hospital Charge Code |
6152647
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$556.10 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,222.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$1,222.20
|
| Rate for Payer: Cash Price |
$1,222.20
|
| Rate for Payer: Cigna Commercial |
$1,731.45
|
| Rate for Payer: First Health Commercial |
$1,833.30
|
| Rate for Payer: First Health Workers Compensation |
$786.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,833.30
|
| Rate for Payer: GEHA Commercial |
$1,629.60
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,833.30
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,815.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,853.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,425.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,833.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,405.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,815.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,935.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,527.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,815.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,894.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$814.80
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$556.10
|
|
|
LASER SURGERY OF PROSTATE
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
CPT 52648
|
| Hospital Charge Code |
6152648
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$592.96 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: First Health Workers Compensation |
$838.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,520.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: Zelis Auto |
$868.80
|
| Rate for Payer: Zelis Worker's Compensation |
$592.96
|
|
