|
PARTIAL REMOVAL OF LARYNX
|
Facility
|
OP
|
$4,018.00
|
|
|
Service Code
|
CPT 31380
|
| Hospital Charge Code |
6131380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,004.50 |
| Max. Negotiated Rate |
$3,817.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,410.80
|
| Rate for Payer: Cash Price |
$2,410.80
|
| Rate for Payer: Cigna Commercial |
$3,415.30
|
| Rate for Payer: First Health Commercial |
$3,616.20
|
| Rate for Payer: First Health Workers Compensation |
$1,551.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,616.20
|
| Rate for Payer: GEHA Commercial |
$3,214.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,616.20
|
| Rate for Payer: Humana ChoiceCare |
$1,044.68
|
| Rate for Payer: Multiplan All |
$3,656.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,410.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,812.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,616.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,817.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,013.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,535.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,004.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,736.74
|
| Rate for Payer: Zelis Auto |
$1,607.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,009.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,096.91
|
|
|
PARTIAL REMOVAL OF LARYNX
|
Facility
|
OP
|
$5,109.00
|
|
|
Service Code
|
CPT 31368
|
| Hospital Charge Code |
6131368
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,277.25 |
| Max. Negotiated Rate |
$4,853.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,065.40
|
| Rate for Payer: Cash Price |
$3,065.40
|
| Rate for Payer: Cigna Commercial |
$4,342.65
|
| Rate for Payer: First Health Commercial |
$4,598.10
|
| Rate for Payer: First Health Workers Compensation |
$1,972.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,598.10
|
| Rate for Payer: GEHA Commercial |
$4,087.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,598.10
|
| Rate for Payer: Humana ChoiceCare |
$1,328.34
|
| Rate for Payer: Multiplan All |
$4,649.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,065.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,576.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,598.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,853.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,831.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,495.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,277.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,751.37
|
| Rate for Payer: Zelis Auto |
$2,043.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,554.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,394.76
|
|
|
PARTIAL REMOVAL OF LARYNX
|
Facility
|
OP
|
$4,577.00
|
|
|
Service Code
|
CPT 31367
|
| Hospital Charge Code |
6131367
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,144.25 |
| Max. Negotiated Rate |
$4,348.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,746.20
|
| Rate for Payer: Cash Price |
$2,746.20
|
| Rate for Payer: Cigna Commercial |
$3,890.45
|
| Rate for Payer: First Health Commercial |
$4,119.30
|
| Rate for Payer: First Health Workers Compensation |
$1,767.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,119.30
|
| Rate for Payer: GEHA Commercial |
$3,661.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,119.30
|
| Rate for Payer: Humana ChoiceCare |
$1,190.02
|
| Rate for Payer: Multiplan All |
$4,165.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,746.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,203.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,119.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,348.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,432.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,027.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,144.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,256.61
|
| Rate for Payer: Zelis Auto |
$1,830.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,288.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,249.52
|
|
|
PARTIAL REMOVAL OF LARYNX
|
Facility
|
IP
|
$4,577.00
|
|
|
Service Code
|
CPT 31367
|
| Hospital Charge Code |
6131367
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,249.52 |
| Max. Negotiated Rate |
$4,348.15 |
| Rate for Payer: Cash Price |
$2,746.20
|
| Rate for Payer: Cigna Commercial |
$3,890.45
|
| Rate for Payer: First Health Commercial |
$4,119.30
|
| Rate for Payer: First Health Workers Compensation |
$1,767.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,119.30
|
| Rate for Payer: GEHA Commercial |
$3,203.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,119.30
|
| Rate for Payer: Multiplan All |
$4,165.07
|
| Rate for Payer: OMNI Networks Commercial |
$3,203.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,119.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,348.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,256.61
|
| Rate for Payer: Zelis Auto |
$1,830.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,249.52
|
|
|
PARTIAL REMOVAL OF LARYNX
|
Facility
|
OP
|
$4,429.00
|
|
|
Service Code
|
CPT 31382
|
| Hospital Charge Code |
6131382
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,107.25 |
| Max. Negotiated Rate |
$4,207.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,657.40
|
| Rate for Payer: Cash Price |
$2,657.40
|
| Rate for Payer: Cigna Commercial |
$3,764.65
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: First Health Workers Compensation |
$1,710.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,986.10
|
| Rate for Payer: GEHA Commercial |
$3,543.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,986.10
|
| Rate for Payer: Humana ChoiceCare |
$1,151.54
|
| Rate for Payer: Multiplan All |
$4,030.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,657.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,100.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,986.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,207.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,321.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,897.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,118.97
|
| Rate for Payer: Zelis Auto |
$1,771.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,214.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,209.12
|
|
|
PARTIAL REMOVAL OF LARYNX
|
Facility
|
IP
|
$4,018.00
|
|
|
Service Code
|
CPT 31380
|
| Hospital Charge Code |
6131380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,096.91 |
| Max. Negotiated Rate |
$3,817.10 |
| Rate for Payer: Cash Price |
$2,410.80
|
| Rate for Payer: Cigna Commercial |
$3,415.30
|
| Rate for Payer: First Health Commercial |
$3,616.20
|
| Rate for Payer: First Health Workers Compensation |
$1,551.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,616.20
|
| Rate for Payer: GEHA Commercial |
$2,812.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,616.20
|
| Rate for Payer: Multiplan All |
$3,656.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,812.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,616.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,817.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,013.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,736.74
|
| Rate for Payer: Zelis Auto |
$1,607.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,096.91
|
|
|
PARTIAL REMOVAL OF LIP
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
CPT 40530
|
| Hospital Charge Code |
6140530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.86 |
| Max. Negotiated Rate |
$6,284.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$498.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,142.47
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$706.35
|
| Rate for Payer: First Health Commercial |
$747.90
|
| Rate for Payer: First Health Workers Compensation |
$320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.90
|
| Rate for Payer: GEHA Commercial |
$664.80
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.90
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$756.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$581.70
|
| Rate for Payer: One Health Plan PPO/POS |
$747.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$789.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$623.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$772.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$332.40
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$226.86
|
|
|
PARTIAL REMOVAL OF LIP
|
Facility
|
IP
|
$831.00
|
|
|
Service Code
|
CPT 40530
|
| Hospital Charge Code |
6140530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.86 |
| Max. Negotiated Rate |
$789.45 |
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$706.35
|
| Rate for Payer: First Health Commercial |
$747.90
|
| Rate for Payer: First Health Workers Compensation |
$320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.90
|
| Rate for Payer: GEHA Commercial |
$581.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.90
|
| Rate for Payer: Multiplan All |
$756.21
|
| Rate for Payer: OMNI Networks Commercial |
$581.70
|
| Rate for Payer: One Health Plan PPO/POS |
$747.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$789.45
|
| Rate for Payer: Three Rivers Provider Network All |
$623.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$772.83
|
| Rate for Payer: Zelis Auto |
$332.40
|
| Rate for Payer: Zelis Worker's Compensation |
$226.86
|
|
|
PARTIAL REMOVAL OF LUNG
|
Facility
|
IP
|
$3,124.00
|
|
|
Service Code
|
CPT 32480
|
| Hospital Charge Code |
6132480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$852.85 |
| Max. Negotiated Rate |
$2,967.80 |
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$2,655.40
|
| Rate for Payer: First Health Commercial |
$2,811.60
|
| Rate for Payer: First Health Workers Compensation |
$1,206.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,811.60
|
| Rate for Payer: GEHA Commercial |
$2,186.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,811.60
|
| Rate for Payer: Multiplan All |
$2,842.84
|
| Rate for Payer: OMNI Networks Commercial |
$2,186.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,811.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,967.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,343.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,905.32
|
| Rate for Payer: Zelis Auto |
$1,249.60
|
| Rate for Payer: Zelis Worker's Compensation |
$852.85
|
|
|
PARTIAL REMOVAL OF LUNG
|
Facility
|
OP
|
$3,124.00
|
|
|
Service Code
|
CPT 32480
|
| Hospital Charge Code |
6132480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$781.00 |
| Max. Negotiated Rate |
$2,967.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$2,655.40
|
| Rate for Payer: First Health Commercial |
$2,811.60
|
| Rate for Payer: First Health Workers Compensation |
$1,206.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,811.60
|
| Rate for Payer: GEHA Commercial |
$2,499.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,811.60
|
| Rate for Payer: Humana ChoiceCare |
$812.24
|
| Rate for Payer: Multiplan All |
$2,842.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,874.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,186.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,811.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,967.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,343.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,749.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$781.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,905.32
|
| Rate for Payer: Zelis Auto |
$1,249.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,562.00
|
| Rate for Payer: Zelis Worker's Compensation |
$852.85
|
|
|
PARTIAL REMOVAL OF NOSE
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT 30150
|
| Hospital Charge Code |
6130150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.79 |
| Max. Negotiated Rate |
$1,478.20 |
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cigna Commercial |
$1,322.60
|
| Rate for Payer: First Health Commercial |
$1,400.40
|
| Rate for Payer: First Health Workers Compensation |
$600.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,400.40
|
| Rate for Payer: GEHA Commercial |
$1,089.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,400.40
|
| Rate for Payer: Multiplan All |
$1,415.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,400.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,478.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,447.08
|
| Rate for Payer: Zelis Auto |
$622.40
|
| Rate for Payer: Zelis Worker's Compensation |
$424.79
|
|
|
PARTIAL REMOVAL OF NOSE
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
CPT 30150
|
| Hospital Charge Code |
6130150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.79 |
| Max. Negotiated Rate |
$11,464.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$933.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,732.16
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cigna Commercial |
$1,322.60
|
| Rate for Payer: First Health Commercial |
$1,400.40
|
| Rate for Payer: First Health Workers Compensation |
$600.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,400.40
|
| Rate for Payer: GEHA Commercial |
$1,244.80
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,400.40
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,415.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,400.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,478.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,447.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$622.40
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$424.79
|
|
|
PARTIAL REMOVAL OF PANCREAS
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
CPT 48140
|
| Hospital Charge Code |
6148140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$823.50 |
| Max. Negotiated Rate |
$3,129.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,976.40
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$2,799.90
|
| Rate for Payer: First Health Commercial |
$2,964.60
|
| Rate for Payer: First Health Workers Compensation |
$1,271.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,964.60
|
| Rate for Payer: GEHA Commercial |
$2,635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,964.60
|
| Rate for Payer: Humana ChoiceCare |
$856.44
|
| Rate for Payer: Multiplan All |
$2,997.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,976.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,305.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,964.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,129.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,470.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,898.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$823.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,063.42
|
| Rate for Payer: Zelis Auto |
$1,317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,647.00
|
| Rate for Payer: Zelis Worker's Compensation |
$899.26
|
|
|
PARTIAL REMOVAL OF PANCREAS
|
Facility
|
OP
|
$3,428.00
|
|
|
Service Code
|
CPT 48145
|
| Hospital Charge Code |
6148145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$857.00 |
| Max. Negotiated Rate |
$3,256.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,056.80
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cigna Commercial |
$2,913.80
|
| Rate for Payer: First Health Commercial |
$3,085.20
|
| Rate for Payer: First Health Workers Compensation |
$1,323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,085.20
|
| Rate for Payer: GEHA Commercial |
$2,742.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,085.20
|
| Rate for Payer: Humana ChoiceCare |
$891.28
|
| Rate for Payer: Multiplan All |
$3,119.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,056.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,399.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,085.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,256.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,016.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$857.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.04
|
| Rate for Payer: Zelis Auto |
$1,371.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,714.00
|
| Rate for Payer: Zelis Worker's Compensation |
$935.84
|
|
|
PARTIAL REMOVAL OF PANCREAS
|
Facility
|
IP
|
$3,428.00
|
|
|
Service Code
|
CPT 48145
|
| Hospital Charge Code |
6148145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$935.84 |
| Max. Negotiated Rate |
$3,256.60 |
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cigna Commercial |
$2,913.80
|
| Rate for Payer: First Health Commercial |
$3,085.20
|
| Rate for Payer: First Health Workers Compensation |
$1,323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,085.20
|
| Rate for Payer: GEHA Commercial |
$2,399.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,085.20
|
| Rate for Payer: Multiplan All |
$3,119.48
|
| Rate for Payer: OMNI Networks Commercial |
$2,399.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,085.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,256.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.04
|
| Rate for Payer: Zelis Auto |
$1,371.20
|
| Rate for Payer: Zelis Worker's Compensation |
$935.84
|
|
|
PARTIAL REMOVAL OF PANCREAS
|
Facility
|
IP
|
$6,569.00
|
|
|
Service Code
|
CPT 48150
|
| Hospital Charge Code |
6148150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,793.34 |
| Max. Negotiated Rate |
$6,240.55 |
| Rate for Payer: Cash Price |
$3,941.40
|
| Rate for Payer: Cigna Commercial |
$5,583.65
|
| Rate for Payer: First Health Commercial |
$5,912.10
|
| Rate for Payer: First Health Workers Compensation |
$2,536.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,912.10
|
| Rate for Payer: GEHA Commercial |
$4,598.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,912.10
|
| Rate for Payer: Multiplan All |
$5,977.79
|
| Rate for Payer: OMNI Networks Commercial |
$4,598.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,912.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,240.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,926.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,109.17
|
| Rate for Payer: Zelis Auto |
$2,627.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,793.34
|
|
|
PARTIAL REMOVAL OF PANCREAS
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
CPT 48140
|
| Hospital Charge Code |
6148140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$899.26 |
| Max. Negotiated Rate |
$3,129.30 |
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$2,799.90
|
| Rate for Payer: First Health Commercial |
$2,964.60
|
| Rate for Payer: First Health Workers Compensation |
$1,271.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,964.60
|
| Rate for Payer: GEHA Commercial |
$2,305.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,964.60
|
| Rate for Payer: Multiplan All |
$2,997.54
|
| Rate for Payer: OMNI Networks Commercial |
$2,305.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,964.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,129.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,470.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,063.42
|
| Rate for Payer: Zelis Auto |
$1,317.60
|
| Rate for Payer: Zelis Worker's Compensation |
$899.26
|
|
|
PARTIAL REMOVAL OF PANCREAS
|
Facility
|
OP
|
$6,569.00
|
|
|
Service Code
|
CPT 48150
|
| Hospital Charge Code |
6148150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,642.25 |
| Max. Negotiated Rate |
$6,240.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,941.40
|
| Rate for Payer: Cash Price |
$3,941.40
|
| Rate for Payer: Cigna Commercial |
$5,583.65
|
| Rate for Payer: First Health Commercial |
$5,912.10
|
| Rate for Payer: First Health Workers Compensation |
$2,536.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,912.10
|
| Rate for Payer: GEHA Commercial |
$5,255.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,912.10
|
| Rate for Payer: Humana ChoiceCare |
$1,707.94
|
| Rate for Payer: Multiplan All |
$5,977.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,941.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,598.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,912.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,240.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,926.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,780.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,642.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,109.17
|
| Rate for Payer: Zelis Auto |
$2,627.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,284.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,793.34
|
|
|
PARTIAL REMOVAL OF PENIS
|
Facility
|
IP
|
$1,299.00
|
|
|
Service Code
|
CPT 54120
|
| Hospital Charge Code |
6154120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.63 |
| Max. Negotiated Rate |
$1,234.05 |
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$1,104.15
|
| Rate for Payer: First Health Commercial |
$1,169.10
|
| Rate for Payer: First Health Workers Compensation |
$501.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,169.10
|
| Rate for Payer: GEHA Commercial |
$909.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,169.10
|
| Rate for Payer: Multiplan All |
$1,182.09
|
| Rate for Payer: OMNI Networks Commercial |
$909.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,169.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,234.05
|
| Rate for Payer: Three Rivers Provider Network All |
$974.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,208.07
|
| Rate for Payer: Zelis Auto |
$519.60
|
| Rate for Payer: Zelis Worker's Compensation |
$354.63
|
|
|
PARTIAL REMOVAL OF PENIS
|
Facility
|
OP
|
$1,299.00
|
|
|
Service Code
|
CPT 54120
|
| Hospital Charge Code |
6154120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.63 |
| Max. Negotiated Rate |
$6,683.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$779.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,341.98
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$1,104.15
|
| Rate for Payer: First Health Commercial |
$1,169.10
|
| Rate for Payer: First Health Workers Compensation |
$501.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,169.10
|
| Rate for Payer: GEHA Commercial |
$1,039.20
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,169.10
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$1,182.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$909.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,169.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,234.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$974.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,208.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$519.60
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$354.63
|
|
|
PARTIAL REMOVAL OF PHARYNX
|
Facility
|
IP
|
$2,982.00
|
|
|
Service Code
|
CPT 42890
|
| Hospital Charge Code |
6142890
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$814.09 |
| Max. Negotiated Rate |
$2,832.90 |
| Rate for Payer: Cash Price |
$1,789.20
|
| Rate for Payer: Cigna Commercial |
$2,534.70
|
| Rate for Payer: First Health Commercial |
$2,683.80
|
| Rate for Payer: First Health Workers Compensation |
$1,151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,683.80
|
| Rate for Payer: GEHA Commercial |
$2,087.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,683.80
|
| Rate for Payer: Multiplan All |
$2,713.62
|
| Rate for Payer: OMNI Networks Commercial |
$2,087.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,683.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,832.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,236.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,773.26
|
| Rate for Payer: Zelis Auto |
$1,192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$814.09
|
|
|
PARTIAL REMOVAL OF PHARYNX
|
Facility
|
OP
|
$2,982.00
|
|
|
Service Code
|
CPT 42890
|
| Hospital Charge Code |
6142890
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$814.09 |
| Max. Negotiated Rate |
$11,464.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,789.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,732.16
|
| Rate for Payer: Cash Price |
$1,789.20
|
| Rate for Payer: Cash Price |
$1,789.20
|
| Rate for Payer: Cigna Commercial |
$2,534.70
|
| Rate for Payer: First Health Commercial |
$2,683.80
|
| Rate for Payer: First Health Workers Compensation |
$1,151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,683.80
|
| Rate for Payer: GEHA Commercial |
$2,385.60
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,683.80
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$2,713.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,087.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,683.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,832.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,236.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,773.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$1,192.80
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$814.09
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 24145
|
| Hospital Charge Code |
6124145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.33 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$726.00
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna Commercial |
$1,028.50
|
| Rate for Payer: First Health Commercial |
$1,089.00
|
| Rate for Payer: First Health Workers Compensation |
$467.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.00
|
| Rate for Payer: GEHA Commercial |
$968.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.00
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,101.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$847.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.00
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,149.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$907.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,125.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$484.00
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$330.33
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 25230
|
| Hospital Charge Code |
6125230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$525.60
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 25151
|
| Hospital Charge Code |
6125151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.87 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$1,011.50
|
| Rate for Payer: First Health Commercial |
$1,071.00
|
| Rate for Payer: First Health Workers Compensation |
$459.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,071.00
|
| Rate for Payer: GEHA Commercial |
$833.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,071.00
|
| Rate for Payer: Multiplan All |
$1,082.90
|
| Rate for Payer: OMNI Networks Commercial |
$833.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,071.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,130.50
|
| Rate for Payer: Three Rivers Provider Network All |
$892.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,106.70
|
| Rate for Payer: Zelis Auto |
$476.00
|
| Rate for Payer: Zelis Worker's Compensation |
$324.87
|
|
