|
RECONSTRUCTION OF JAW JOINT
|
Facility
|
IP
|
$3,514.00
|
|
|
Service Code
|
CPT 21243
|
| Hospital Charge Code |
6121243
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$959.32 |
| Max. Negotiated Rate |
$3,338.30 |
| Rate for Payer: Cash Price |
$2,108.40
|
| Rate for Payer: Cigna Commercial |
$2,986.90
|
| Rate for Payer: First Health Commercial |
$3,162.60
|
| Rate for Payer: First Health Workers Compensation |
$1,356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,162.60
|
| Rate for Payer: GEHA Commercial |
$2,459.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,162.60
|
| Rate for Payer: Multiplan All |
$3,197.74
|
| Rate for Payer: OMNI Networks Commercial |
$2,459.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,162.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,338.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,635.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,268.02
|
| Rate for Payer: Zelis Auto |
$1,405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$959.32
|
|
|
RECONSTRUCTION OF JAW JOINT
|
Facility
|
OP
|
$3,514.00
|
|
|
Service Code
|
CPT 21243
|
| Hospital Charge Code |
6121243
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$959.32 |
| Max. Negotiated Rate |
$34,924.18 |
| 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 |
$2,108.40
|
| 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 |
$17,462.09
|
| Rate for Payer: Cash Price |
$2,108.40
|
| Rate for Payer: Cash Price |
$2,108.40
|
| Rate for Payer: Cigna Commercial |
$2,986.90
|
| Rate for Payer: First Health Commercial |
$3,162.60
|
| Rate for Payer: First Health Workers Compensation |
$1,356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,162.60
|
| Rate for Payer: GEHA Commercial |
$2,811.20
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,162.60
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$3,197.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,459.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,162.60
|
| 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 |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,338.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,635.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,268.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$1,405.60
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$959.32
|
|
|
RECONSTRUCTION OF NAIL BED
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 11762
|
| Hospital Charge Code |
6111762
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna Commercial |
$476.00
|
| Rate for Payer: First Health Commercial |
$504.00
|
| Rate for Payer: First Health Workers Compensation |
$216.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.00
|
| Rate for Payer: GEHA Commercial |
$448.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.00
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$509.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$392.00
|
| Rate for Payer: One Health Plan PPO/POS |
$504.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$420.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$520.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$224.00
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$152.88
|
|
|
RECONSTRUCTION OF NAIL BED
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 11762
|
| Hospital Charge Code |
6111762
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna Commercial |
$476.00
|
| Rate for Payer: First Health Commercial |
$504.00
|
| Rate for Payer: First Health Workers Compensation |
$216.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.00
|
| Rate for Payer: GEHA Commercial |
$392.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.00
|
| Rate for Payer: Multiplan All |
$509.60
|
| Rate for Payer: OMNI Networks Commercial |
$392.00
|
| Rate for Payer: One Health Plan PPO/POS |
$504.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.00
|
| Rate for Payer: Three Rivers Provider Network All |
$420.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$520.80
|
| Rate for Payer: Zelis Auto |
$224.00
|
| Rate for Payer: Zelis Worker's Compensation |
$152.88
|
|
|
RECONSTRUCTION OF NOSE
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT 30410
|
| Hospital Charge Code |
6130410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cigna Commercial |
$2,023.00
|
| Rate for Payer: First Health Commercial |
$2,142.00
|
| Rate for Payer: First Health Workers Compensation |
$918.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,142.00
|
| Rate for Payer: GEHA Commercial |
$1,666.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,142.00
|
| Rate for Payer: Multiplan All |
$2,165.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,666.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,142.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,261.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,785.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,213.40
|
| Rate for Payer: Zelis Auto |
$952.00
|
| Rate for Payer: Zelis Worker's Compensation |
$649.74
|
|
|
RECONSTRUCTION OF NOSE
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
CPT 30400
|
| Hospital Charge Code |
6130400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$553.10 |
| Max. Negotiated Rate |
$11,234.32 |
| 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 |
$1,215.60
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,215.60
|
| Rate for Payer: Cash Price |
$1,215.60
|
| Rate for Payer: Cigna Commercial |
$1,722.10
|
| Rate for Payer: First Health Commercial |
$1,823.40
|
| Rate for Payer: First Health Workers Compensation |
$782.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,823.40
|
| Rate for Payer: GEHA Commercial |
$1,620.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,823.40
|
| 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 |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,843.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,823.40
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,924.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,519.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,884.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$810.40
|
| 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 |
$553.10
|
|
|
RECONSTRUCTION OF NOSE
|
Facility
|
OP
|
$2,766.00
|
|
|
Service Code
|
CPT 30420
|
| Hospital Charge Code |
6130420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$755.12 |
| Max. Negotiated Rate |
$11,234.32 |
| 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 |
$1,659.60
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,659.60
|
| Rate for Payer: Cash Price |
$1,659.60
|
| Rate for Payer: Cigna Commercial |
$2,351.10
|
| Rate for Payer: First Health Commercial |
$2,489.40
|
| Rate for Payer: First Health Workers Compensation |
$1,067.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,489.40
|
| Rate for Payer: GEHA Commercial |
$2,212.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,489.40
|
| 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 |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,517.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,936.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,489.40
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,627.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,074.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,572.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,106.40
|
| 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 |
$755.12
|
|
|
RECONSTRUCTION OF NOSE
|
Facility
|
IP
|
$2,766.00
|
|
|
Service Code
|
CPT 30420
|
| Hospital Charge Code |
6130420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$755.12 |
| Max. Negotiated Rate |
$2,627.70 |
| Rate for Payer: Cash Price |
$1,659.60
|
| Rate for Payer: Cigna Commercial |
$2,351.10
|
| Rate for Payer: First Health Commercial |
$2,489.40
|
| Rate for Payer: First Health Workers Compensation |
$1,067.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,489.40
|
| Rate for Payer: GEHA Commercial |
$1,936.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,489.40
|
| Rate for Payer: Multiplan All |
$2,517.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,936.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,489.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,627.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,074.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,572.38
|
| Rate for Payer: Zelis Auto |
$1,106.40
|
| Rate for Payer: Zelis Worker's Compensation |
$755.12
|
|
|
RECONSTRUCTION OF NOSE
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
CPT 30400
|
| Hospital Charge Code |
6130400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$553.10 |
| Max. Negotiated Rate |
$1,924.70 |
| Rate for Payer: Cash Price |
$1,215.60
|
| Rate for Payer: Cigna Commercial |
$1,722.10
|
| Rate for Payer: First Health Commercial |
$1,823.40
|
| Rate for Payer: First Health Workers Compensation |
$782.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,823.40
|
| Rate for Payer: GEHA Commercial |
$1,418.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,823.40
|
| Rate for Payer: Multiplan All |
$1,843.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,823.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,924.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,519.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,884.18
|
| Rate for Payer: Zelis Auto |
$810.40
|
| Rate for Payer: Zelis Worker's Compensation |
$553.10
|
|
|
RECONSTRUCTION OF NOSE
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT 30410
|
| Hospital Charge Code |
6130410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$11,234.32 |
| 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 |
$1,428.00
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cigna Commercial |
$2,023.00
|
| Rate for Payer: First Health Commercial |
$2,142.00
|
| Rate for Payer: First Health Workers Compensation |
$918.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,142.00
|
| Rate for Payer: GEHA Commercial |
$1,904.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,142.00
|
| 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 |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,165.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,666.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,142.00
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,261.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,785.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,213.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$952.00
|
| 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 |
$649.74
|
|
|
RECONSTRUCTION OF PYLORUS
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 43800
|
| Hospital Charge Code |
6143800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$488.75 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$1,661.75
|
| Rate for Payer: First Health Commercial |
$1,759.50
|
| Rate for Payer: First Health Workers Compensation |
$754.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,759.50
|
| Rate for Payer: GEHA Commercial |
$1,564.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$508.30
|
| Rate for Payer: Multiplan All |
$1,779.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,173.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,368.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,759.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,857.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,466.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,720.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$488.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,818.15
|
| Rate for Payer: Zelis Auto |
$782.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$977.50
|
| Rate for Payer: Zelis Worker's Compensation |
$533.72
|
|
|
RECONSTRUCTION OF PYLORUS
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 43800
|
| Hospital Charge Code |
6143800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$533.72 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$1,661.75
|
| Rate for Payer: First Health Commercial |
$1,759.50
|
| Rate for Payer: First Health Workers Compensation |
$754.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,759.50
|
| Rate for Payer: GEHA Commercial |
$1,368.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,759.50
|
| Rate for Payer: Multiplan All |
$1,779.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,368.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,759.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,857.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,466.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,818.15
|
| Rate for Payer: Zelis Auto |
$782.00
|
| Rate for Payer: Zelis Worker's Compensation |
$533.72
|
|
|
RECONSTRUCTION OF STERNUM
|
Facility
|
IP
|
$2,148.00
|
|
|
Service Code
|
CPT 21740
|
| Hospital Charge Code |
6121740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,503.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
RECONSTRUCTION OF STERNUM
|
Facility
|
OP
|
$2,148.00
|
|
|
Service Code
|
CPT 21740
|
| Hospital Charge Code |
6121740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Humana ChoiceCare |
$558.48
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,288.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,890.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$537.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,074.00
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
RECONSTRUCTION OF THROAT
|
Facility
|
IP
|
$1,679.00
|
|
|
Service Code
|
CPT 42950
|
| Hospital Charge Code |
6142950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$458.37 |
| Max. Negotiated Rate |
$1,595.05 |
| Rate for Payer: Cash Price |
$1,007.40
|
| Rate for Payer: Cigna Commercial |
$1,427.15
|
| Rate for Payer: First Health Commercial |
$1,511.10
|
| Rate for Payer: First Health Workers Compensation |
$648.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,511.10
|
| Rate for Payer: GEHA Commercial |
$1,175.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,511.10
|
| Rate for Payer: Multiplan All |
$1,527.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,175.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,511.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,595.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,259.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,561.47
|
| Rate for Payer: Zelis Auto |
$671.60
|
| Rate for Payer: Zelis Worker's Compensation |
$458.37
|
|
|
RECONSTRUCTION OF THROAT
|
Facility
|
OP
|
$1,679.00
|
|
|
Service Code
|
CPT 42950
|
| Hospital Charge Code |
6142950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$458.37 |
| Max. Negotiated Rate |
$11,234.32 |
| 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 |
$1,007.40
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,007.40
|
| Rate for Payer: Cash Price |
$1,007.40
|
| Rate for Payer: Cigna Commercial |
$1,427.15
|
| Rate for Payer: First Health Commercial |
$1,511.10
|
| Rate for Payer: First Health Workers Compensation |
$648.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,511.10
|
| Rate for Payer: GEHA Commercial |
$1,343.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,511.10
|
| 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 |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,527.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,175.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,511.10
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,595.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,259.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,561.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$671.60
|
| 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 |
$458.37
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$1,582.00
|
|
|
Service Code
|
CPT 54322
|
| Hospital Charge Code |
6154322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.89 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$949.20
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cigna Commercial |
$1,344.70
|
| Rate for Payer: First Health Commercial |
$1,423.80
|
| Rate for Payer: First Health Workers Compensation |
$610.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,423.80
|
| Rate for Payer: GEHA Commercial |
$1,265.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,423.80
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,439.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,107.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,423.80
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,502.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,186.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,471.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$632.80
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$431.89
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$2,054.00
|
|
|
Service Code
|
CPT 54324
|
| Hospital Charge Code |
6154324
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$560.74 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$1,232.40
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$1,745.90
|
| Rate for Payer: First Health Commercial |
$1,848.60
|
| Rate for Payer: First Health Workers Compensation |
$793.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,848.60
|
| Rate for Payer: GEHA Commercial |
$1,643.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,848.60
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,869.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,437.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,848.60
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,951.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,540.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,910.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$821.60
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$560.74
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 54326
|
| Hospital Charge Code |
6154326
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$532.35 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cigna Commercial |
$1,657.50
|
| Rate for Payer: First Health Commercial |
$1,755.00
|
| Rate for Payer: First Health Workers Compensation |
$752.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,755.00
|
| Rate for Payer: GEHA Commercial |
$1,365.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,755.00
|
| Rate for Payer: Multiplan All |
$1,774.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,365.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,755.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,852.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,462.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,813.50
|
| Rate for Payer: Zelis Auto |
$780.00
|
| Rate for Payer: Zelis Worker's Compensation |
$532.35
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 54318
|
| Hospital Charge Code |
6154318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.15 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$923.40
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cigna Commercial |
$1,308.15
|
| Rate for Payer: First Health Commercial |
$1,385.10
|
| Rate for Payer: First Health Workers Compensation |
$594.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,385.10
|
| Rate for Payer: GEHA Commercial |
$1,231.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,385.10
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,400.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,077.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,385.10
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,462.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,154.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,431.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$615.60
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$420.15
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 54326
|
| Hospital Charge Code |
6154326
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$532.35 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$1,170.00
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cigna Commercial |
$1,657.50
|
| Rate for Payer: First Health Commercial |
$1,755.00
|
| Rate for Payer: First Health Workers Compensation |
$752.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,755.00
|
| Rate for Payer: GEHA Commercial |
$1,560.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,755.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,774.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,365.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,755.00
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,852.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,462.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,813.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$780.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$532.35
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$1,582.00
|
|
|
Service Code
|
CPT 54322
|
| Hospital Charge Code |
6154322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.89 |
| Max. Negotiated Rate |
$1,502.90 |
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cigna Commercial |
$1,344.70
|
| Rate for Payer: First Health Commercial |
$1,423.80
|
| Rate for Payer: First Health Workers Compensation |
$610.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,423.80
|
| Rate for Payer: GEHA Commercial |
$1,107.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,423.80
|
| Rate for Payer: Multiplan All |
$1,439.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,107.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,423.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,502.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,186.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,471.26
|
| Rate for Payer: Zelis Auto |
$632.80
|
| Rate for Payer: Zelis Worker's Compensation |
$431.89
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 54308
|
| Hospital Charge Code |
6154308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$9,654.20 |
| 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 |
$883.20
|
| 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 |
$4,827.10
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: First Health Workers Compensation |
$568.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,177.60
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| 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 |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| 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 |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$588.80
|
| 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 |
$401.86
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
CPT 53415
|
| Hospital Charge Code |
6153415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$583.25 |
| Max. Negotiated Rate |
$2,216.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,399.80
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$1,983.05
|
| Rate for Payer: First Health Commercial |
$2,099.70
|
| Rate for Payer: First Health Workers Compensation |
$900.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,099.70
|
| Rate for Payer: GEHA Commercial |
$1,866.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,099.70
|
| Rate for Payer: Humana ChoiceCare |
$606.58
|
| Rate for Payer: Multiplan All |
$2,123.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,399.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,633.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,099.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,216.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,749.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,053.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,169.69
|
| Rate for Payer: Zelis Auto |
$933.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,166.50
|
| Rate for Payer: Zelis Worker's Compensation |
$636.91
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 54308
|
| Hospital Charge Code |
6154308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: First Health Workers Compensation |
$568.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,030.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
| Rate for Payer: Zelis Worker's Compensation |
$401.86
|
|
