|
PARTIAL REMOVAL OF BLADDER
|
Facility
|
OP
|
$2,625.00
|
|
|
Service Code
|
CPT 51555
|
| Hospital Charge Code |
6151555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$2,493.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cigna Commercial |
$2,231.25
|
| Rate for Payer: First Health Commercial |
$2,362.50
|
| Rate for Payer: First Health Workers Compensation |
$1,013.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,362.50
|
| Rate for Payer: GEHA Commercial |
$2,100.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,362.50
|
| Rate for Payer: Humana ChoiceCare |
$682.50
|
| Rate for Payer: Multiplan All |
$2,388.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,575.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,837.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,362.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,493.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,310.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$656.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,441.25
|
| Rate for Payer: Zelis Auto |
$1,050.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,312.50
|
| Rate for Payer: Zelis Worker's Compensation |
$716.62
|
|
|
PARTIAL REMOVAL OF BLADDER
|
Facility
|
IP
|
$2,625.00
|
|
|
Service Code
|
CPT 51555
|
| Hospital Charge Code |
6151555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$716.62 |
| Max. Negotiated Rate |
$2,493.75 |
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cigna Commercial |
$2,231.25
|
| Rate for Payer: First Health Commercial |
$2,362.50
|
| Rate for Payer: First Health Workers Compensation |
$1,013.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,362.50
|
| Rate for Payer: GEHA Commercial |
$1,837.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,362.50
|
| Rate for Payer: Multiplan All |
$2,388.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,837.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,362.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,493.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,968.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,441.25
|
| Rate for Payer: Zelis Auto |
$1,050.00
|
| Rate for Payer: Zelis Worker's Compensation |
$716.62
|
|
|
PARTIAL REMOVAL OF BLADDER
|
Facility
|
OP
|
$1,994.00
|
|
|
Service Code
|
CPT 51550
|
| Hospital Charge Code |
6151550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$498.50 |
| Max. Negotiated Rate |
$1,894.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,196.40
|
| Rate for Payer: Cash Price |
$1,196.40
|
| Rate for Payer: Cigna Commercial |
$1,694.90
|
| Rate for Payer: First Health Commercial |
$1,794.60
|
| Rate for Payer: First Health Workers Compensation |
$769.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,794.60
|
| Rate for Payer: GEHA Commercial |
$1,595.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,794.60
|
| Rate for Payer: Humana ChoiceCare |
$518.44
|
| Rate for Payer: Multiplan All |
$1,814.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,196.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,395.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,794.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,894.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,495.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,754.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$498.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,854.42
|
| Rate for Payer: Zelis Auto |
$797.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$997.00
|
| Rate for Payer: Zelis Worker's Compensation |
$544.36
|
|
|
PARTIAL REMOVAL OF BLADDER
|
Facility
|
IP
|
$1,994.00
|
|
|
Service Code
|
CPT 51550
|
| Hospital Charge Code |
6151550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$544.36 |
| Max. Negotiated Rate |
$1,894.30 |
| Rate for Payer: Cash Price |
$1,196.40
|
| Rate for Payer: Cigna Commercial |
$1,694.90
|
| Rate for Payer: First Health Commercial |
$1,794.60
|
| Rate for Payer: First Health Workers Compensation |
$769.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,794.60
|
| Rate for Payer: GEHA Commercial |
$1,395.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,794.60
|
| Rate for Payer: Multiplan All |
$1,814.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,395.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,794.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,894.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,495.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,854.42
|
| Rate for Payer: Zelis Auto |
$797.60
|
| Rate for Payer: Zelis Worker's Compensation |
$544.36
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$2,824.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
6144140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$706.00 |
| Max. Negotiated Rate |
$2,682.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,694.40
|
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cigna Commercial |
$2,400.40
|
| Rate for Payer: First Health Commercial |
$2,541.60
|
| Rate for Payer: First Health Workers Compensation |
$1,090.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,541.60
|
| Rate for Payer: GEHA Commercial |
$2,259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,541.60
|
| Rate for Payer: Humana ChoiceCare |
$734.24
|
| Rate for Payer: Multiplan All |
$2,569.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,694.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,976.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,541.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,682.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,118.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,485.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$706.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,626.32
|
| Rate for Payer: Zelis Auto |
$1,129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,412.00
|
| Rate for Payer: Zelis Worker's Compensation |
$770.95
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
CPT 44144
|
| Hospital Charge Code |
6144144
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$932.75 |
| Max. Negotiated Rate |
$3,544.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,238.60
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cigna Commercial |
$3,171.35
|
| Rate for Payer: First Health Commercial |
$3,357.90
|
| Rate for Payer: First Health Workers Compensation |
$1,440.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,357.90
|
| Rate for Payer: GEHA Commercial |
$2,984.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,357.90
|
| Rate for Payer: Humana ChoiceCare |
$970.06
|
| Rate for Payer: Multiplan All |
$3,395.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,238.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,611.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,357.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,544.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,798.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$932.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,469.83
|
| Rate for Payer: Zelis Auto |
$1,492.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,865.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,018.56
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$3,492.00
|
|
|
Service Code
|
CPT 44145
|
| Hospital Charge Code |
6144145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$953.32 |
| Max. Negotiated Rate |
$3,317.40 |
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cigna Commercial |
$2,968.20
|
| Rate for Payer: First Health Commercial |
$3,142.80
|
| Rate for Payer: First Health Workers Compensation |
$1,348.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,142.80
|
| Rate for Payer: GEHA Commercial |
$2,444.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,142.80
|
| Rate for Payer: Multiplan All |
$3,177.72
|
| Rate for Payer: OMNI Networks Commercial |
$2,444.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,142.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,317.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,619.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,247.56
|
| Rate for Payer: Zelis Auto |
$1,396.80
|
| Rate for Payer: Zelis Worker's Compensation |
$953.32
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$3,492.00
|
|
|
Service Code
|
CPT 44145
|
| Hospital Charge Code |
6144145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$873.00 |
| Max. Negotiated Rate |
$3,317.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,095.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cigna Commercial |
$2,968.20
|
| Rate for Payer: First Health Commercial |
$3,142.80
|
| Rate for Payer: First Health Workers Compensation |
$1,348.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,142.80
|
| Rate for Payer: GEHA Commercial |
$2,793.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,142.80
|
| Rate for Payer: Humana ChoiceCare |
$907.92
|
| Rate for Payer: Multiplan All |
$3,177.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,095.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,444.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,142.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,317.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,619.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,072.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,247.56
|
| Rate for Payer: Zelis Auto |
$1,396.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,746.00
|
| Rate for Payer: Zelis Worker's Compensation |
$953.32
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$4,103.00
|
|
|
Service Code
|
CPT 44147
|
| Hospital Charge Code |
6144147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,025.75 |
| Max. Negotiated Rate |
$3,897.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,461.80
|
| Rate for Payer: Cash Price |
$2,461.80
|
| Rate for Payer: Cigna Commercial |
$3,487.55
|
| Rate for Payer: First Health Commercial |
$3,692.70
|
| Rate for Payer: First Health Workers Compensation |
$1,584.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,692.70
|
| Rate for Payer: GEHA Commercial |
$3,282.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,692.70
|
| Rate for Payer: Humana ChoiceCare |
$1,066.78
|
| Rate for Payer: Multiplan All |
$3,733.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,461.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,872.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,692.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,897.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,077.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,610.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,025.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,815.79
|
| Rate for Payer: Zelis Auto |
$1,641.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,051.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,120.12
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$3,837.00
|
|
|
Service Code
|
CPT 44141
|
| Hospital Charge Code |
6144141
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,047.50 |
| Max. Negotiated Rate |
$3,645.15 |
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cigna Commercial |
$3,261.45
|
| Rate for Payer: First Health Commercial |
$3,453.30
|
| Rate for Payer: First Health Workers Compensation |
$1,481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,453.30
|
| Rate for Payer: GEHA Commercial |
$2,685.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,453.30
|
| Rate for Payer: Multiplan All |
$3,491.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,685.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,453.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,645.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,877.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,568.41
|
| Rate for Payer: Zelis Auto |
$1,534.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,047.50
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$3,837.00
|
|
|
Service Code
|
CPT 44141
|
| Hospital Charge Code |
6144141
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$959.25 |
| Max. Negotiated Rate |
$3,645.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,302.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cigna Commercial |
$3,261.45
|
| Rate for Payer: First Health Commercial |
$3,453.30
|
| Rate for Payer: First Health Workers Compensation |
$1,481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,453.30
|
| Rate for Payer: GEHA Commercial |
$3,069.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,453.30
|
| Rate for Payer: Humana ChoiceCare |
$997.62
|
| Rate for Payer: Multiplan All |
$3,491.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,302.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,685.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,453.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,645.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,877.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,376.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$959.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,568.41
|
| Rate for Payer: Zelis Auto |
$1,534.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,918.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,047.50
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 44143
|
| Hospital Charge Code |
6144143
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$956.59 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$2,978.40
|
| Rate for Payer: First Health Commercial |
$3,153.60
|
| Rate for Payer: First Health Workers Compensation |
$1,352.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,153.60
|
| Rate for Payer: GEHA Commercial |
$2,452.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,153.60
|
| Rate for Payer: Multiplan All |
$3,188.64
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,153.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,328.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,258.72
|
| Rate for Payer: Zelis Auto |
$1,401.60
|
| Rate for Payer: Zelis Worker's Compensation |
$956.59
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
CPT 44144
|
| Hospital Charge Code |
6144144
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,018.56 |
| Max. Negotiated Rate |
$3,544.45 |
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cigna Commercial |
$3,171.35
|
| Rate for Payer: First Health Commercial |
$3,357.90
|
| Rate for Payer: First Health Workers Compensation |
$1,440.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,357.90
|
| Rate for Payer: GEHA Commercial |
$2,611.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,357.90
|
| Rate for Payer: Multiplan All |
$3,395.21
|
| Rate for Payer: OMNI Networks Commercial |
$2,611.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,357.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,544.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,798.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,469.83
|
| Rate for Payer: Zelis Auto |
$1,492.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,018.56
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$4,447.00
|
|
|
Service Code
|
CPT 44146
|
| Hospital Charge Code |
6144146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,214.03 |
| Max. Negotiated Rate |
$4,224.65 |
| Rate for Payer: Cash Price |
$2,668.20
|
| Rate for Payer: Cigna Commercial |
$3,779.95
|
| Rate for Payer: First Health Commercial |
$4,002.30
|
| Rate for Payer: First Health Workers Compensation |
$1,716.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,002.30
|
| Rate for Payer: GEHA Commercial |
$3,112.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,002.30
|
| Rate for Payer: Multiplan All |
$4,046.77
|
| Rate for Payer: OMNI Networks Commercial |
$3,112.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,002.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,224.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,335.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,135.71
|
| Rate for Payer: Zelis Auto |
$1,778.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,214.03
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$4,447.00
|
|
|
Service Code
|
CPT 44146
|
| Hospital Charge Code |
6144146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,111.75 |
| Max. Negotiated Rate |
$4,224.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,668.20
|
| Rate for Payer: Cash Price |
$2,668.20
|
| Rate for Payer: Cigna Commercial |
$3,779.95
|
| Rate for Payer: First Health Commercial |
$4,002.30
|
| Rate for Payer: First Health Workers Compensation |
$1,716.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,002.30
|
| Rate for Payer: GEHA Commercial |
$3,557.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,002.30
|
| Rate for Payer: Humana ChoiceCare |
$1,156.22
|
| Rate for Payer: Multiplan All |
$4,046.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,112.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,002.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,224.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,335.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,913.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,135.71
|
| Rate for Payer: Zelis Auto |
$1,778.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,223.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,214.03
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$4,103.00
|
|
|
Service Code
|
CPT 44147
|
| Hospital Charge Code |
6144147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,120.12 |
| Max. Negotiated Rate |
$3,897.85 |
| Rate for Payer: Cash Price |
$2,461.80
|
| Rate for Payer: Cigna Commercial |
$3,487.55
|
| Rate for Payer: First Health Commercial |
$3,692.70
|
| Rate for Payer: First Health Workers Compensation |
$1,584.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,692.70
|
| Rate for Payer: GEHA Commercial |
$2,872.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,692.70
|
| Rate for Payer: Multiplan All |
$3,733.73
|
| Rate for Payer: OMNI Networks Commercial |
$2,872.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,692.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,897.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,077.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,815.79
|
| Rate for Payer: Zelis Auto |
$1,641.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,120.12
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 44143
|
| Hospital Charge Code |
6144143
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$876.00 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$2,978.40
|
| Rate for Payer: First Health Commercial |
$3,153.60
|
| Rate for Payer: First Health Workers Compensation |
$1,352.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,153.60
|
| Rate for Payer: GEHA Commercial |
$2,803.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,153.60
|
| Rate for Payer: Humana ChoiceCare |
$911.04
|
| Rate for Payer: Multiplan All |
$3,188.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,102.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,153.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,328.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,083.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$876.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,258.72
|
| Rate for Payer: Zelis Auto |
$1,401.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,752.00
|
| Rate for Payer: Zelis Worker's Compensation |
$956.59
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$2,824.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
6144140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$770.95 |
| Max. Negotiated Rate |
$2,682.80 |
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cigna Commercial |
$2,400.40
|
| Rate for Payer: First Health Commercial |
$2,541.60
|
| Rate for Payer: First Health Workers Compensation |
$1,090.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,541.60
|
| Rate for Payer: GEHA Commercial |
$1,976.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,541.60
|
| Rate for Payer: Multiplan All |
$2,569.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,976.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,541.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,682.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,626.32
|
| Rate for Payer: Zelis Auto |
$1,129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$770.95
|
|
|
PARTIAL REMOVAL OF ELBOW
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 24147
|
| Hospital Charge Code |
6124147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.35 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: First Health Workers Compensation |
$488.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$885.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Worker's Compensation |
$345.35
|
|
|
PARTIAL REMOVAL OF ELBOW
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 24147
|
| Hospital Charge Code |
6124147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.35 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: First Health Workers Compensation |
$488.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$1,012.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$345.35
|
|
|
PARTIAL REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$6,110.00
|
|
|
Service Code
|
CPT 43121
|
| Hospital Charge Code |
6143121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,668.03 |
| Max. Negotiated Rate |
$5,804.50 |
| Rate for Payer: Cash Price |
$3,666.00
|
| Rate for Payer: Cigna Commercial |
$5,193.50
|
| Rate for Payer: First Health Commercial |
$5,499.00
|
| Rate for Payer: First Health Workers Compensation |
$2,359.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,499.00
|
| Rate for Payer: GEHA Commercial |
$4,277.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,499.00
|
| Rate for Payer: Multiplan All |
$5,560.10
|
| Rate for Payer: OMNI Networks Commercial |
$4,277.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,499.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,804.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,582.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,682.30
|
| Rate for Payer: Zelis Auto |
$2,444.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,668.03
|
|
|
PARTIAL REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$5,242.00
|
|
|
Service Code
|
CPT 43117
|
| Hospital Charge Code |
6143117
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,431.07 |
| Max. Negotiated Rate |
$4,979.90 |
| Rate for Payer: Cash Price |
$3,145.20
|
| Rate for Payer: Cigna Commercial |
$4,455.70
|
| Rate for Payer: First Health Commercial |
$4,717.80
|
| Rate for Payer: First Health Workers Compensation |
$2,023.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,717.80
|
| Rate for Payer: GEHA Commercial |
$3,669.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,717.80
|
| Rate for Payer: Multiplan All |
$4,770.22
|
| Rate for Payer: OMNI Networks Commercial |
$3,669.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,717.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,979.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,931.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,875.06
|
| Rate for Payer: Zelis Auto |
$2,096.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,431.07
|
|
|
PARTIAL REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$7,851.00
|
|
|
Service Code
|
CPT 43118
|
| Hospital Charge Code |
6143118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,962.75 |
| Max. Negotiated Rate |
$7,458.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,710.60
|
| Rate for Payer: Cash Price |
$4,710.60
|
| Rate for Payer: Cigna Commercial |
$6,673.35
|
| Rate for Payer: First Health Commercial |
$7,065.90
|
| Rate for Payer: First Health Workers Compensation |
$3,031.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,065.90
|
| Rate for Payer: GEHA Commercial |
$6,280.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,065.90
|
| Rate for Payer: Humana ChoiceCare |
$2,041.26
|
| Rate for Payer: Multiplan All |
$7,144.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,710.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,495.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,065.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,458.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,888.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,908.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,962.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,301.43
|
| Rate for Payer: Zelis Auto |
$3,140.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,925.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,143.32
|
|
|
PARTIAL REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$10,583.00
|
|
|
Service Code
|
CPT 43116
|
| Hospital Charge Code |
6143116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,889.16 |
| Max. Negotiated Rate |
$10,053.85 |
| Rate for Payer: Cash Price |
$6,349.80
|
| Rate for Payer: Cigna Commercial |
$8,995.55
|
| Rate for Payer: First Health Commercial |
$9,524.70
|
| Rate for Payer: First Health Workers Compensation |
$4,086.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,524.70
|
| Rate for Payer: GEHA Commercial |
$7,408.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,524.70
|
| Rate for Payer: Multiplan All |
$9,630.53
|
| Rate for Payer: OMNI Networks Commercial |
$7,408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$9,524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,053.85
|
| Rate for Payer: Three Rivers Provider Network All |
$7,937.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,842.19
|
| Rate for Payer: Zelis Auto |
$4,233.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,889.16
|
|
|
PARTIAL REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$5,242.00
|
|
|
Service Code
|
CPT 43117
|
| Hospital Charge Code |
6143117
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,310.50 |
| Max. Negotiated Rate |
$4,979.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,145.20
|
| Rate for Payer: Cash Price |
$3,145.20
|
| Rate for Payer: Cigna Commercial |
$4,455.70
|
| Rate for Payer: First Health Commercial |
$4,717.80
|
| Rate for Payer: First Health Workers Compensation |
$2,023.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,717.80
|
| Rate for Payer: GEHA Commercial |
$4,193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,717.80
|
| Rate for Payer: Humana ChoiceCare |
$1,362.92
|
| Rate for Payer: Multiplan All |
$4,770.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,145.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,669.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,717.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,979.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,931.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,612.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,310.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,875.06
|
| Rate for Payer: Zelis Auto |
$2,096.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,621.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,431.07
|
|
