|
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
|
IP
|
$1,772.00
|
|
|
Service Code
|
CPT 54312
|
| Hospital Charge Code |
6154312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$483.76 |
| Max. Negotiated Rate |
$1,683.40 |
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$1,506.20
|
| Rate for Payer: First Health Commercial |
$1,594.80
|
| Rate for Payer: First Health Workers Compensation |
$684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,594.80
|
| Rate for Payer: GEHA Commercial |
$1,240.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,594.80
|
| Rate for Payer: Multiplan All |
$1,612.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,240.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,594.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,683.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,647.96
|
| Rate for Payer: Zelis Auto |
$708.80
|
| Rate for Payer: Zelis Worker's Compensation |
$483.76
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
CPT 53415
|
| Hospital Charge Code |
6153415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$636.91 |
| Max. Negotiated Rate |
$2,216.35 |
| 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 |
$1,633.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,099.70
|
| Rate for Payer: Multiplan All |
$2,123.03
|
| 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: United Payors & United Providers UP&UP |
$2,169.69
|
| Rate for Payer: Zelis Auto |
$933.20
|
| Rate for Payer: Zelis Worker's Compensation |
$636.91
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$2,054.00
|
|
|
Service Code
|
CPT 54324
|
| Hospital Charge Code |
6154324
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$560.74 |
| Max. Negotiated Rate |
$1,951.30 |
| 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 |
$1,437.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,848.60
|
| Rate for Payer: Multiplan All |
$1,869.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,437.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,848.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,951.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,910.22
|
| Rate for Payer: Zelis Auto |
$821.60
|
| Rate for Payer: Zelis Worker's Compensation |
$560.74
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$2,017.00
|
|
|
Service Code
|
CPT 53410
|
| Hospital Charge Code |
6153410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$550.64 |
| Max. Negotiated Rate |
$1,916.15 |
| Rate for Payer: Cash Price |
$1,210.20
|
| Rate for Payer: Cigna Commercial |
$1,714.45
|
| Rate for Payer: First Health Commercial |
$1,815.30
|
| Rate for Payer: First Health Workers Compensation |
$778.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,815.30
|
| Rate for Payer: GEHA Commercial |
$1,411.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,815.30
|
| Rate for Payer: Multiplan All |
$1,835.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,411.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,815.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,916.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,512.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,875.81
|
| Rate for Payer: Zelis Auto |
$806.80
|
| Rate for Payer: Zelis Worker's Compensation |
$550.64
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$2,163.00
|
|
|
Service Code
|
CPT 54316
|
| Hospital Charge Code |
6154316
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$590.50 |
| Max. Negotiated Rate |
$17,920.60 |
| 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 |
$1,297.80
|
| 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 |
$8,960.30
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cigna Commercial |
$1,838.55
|
| Rate for Payer: First Health Commercial |
$1,946.70
|
| Rate for Payer: First Health Workers Compensation |
$835.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,946.70
|
| Rate for Payer: GEHA Commercial |
$1,730.40
|
| Rate for Payer: GEHA Medicare |
$8,960.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,946.70
|
| Rate for Payer: Humana ChoiceCare |
$9,856.33
|
| Rate for Payer: Humana Medicare Advantage |
$8,960.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15,053.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,960.30
|
| Rate for Payer: Multiplan All |
$1,968.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15,232.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,514.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,946.70
|
| 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 |
$8,960.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,054.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,920.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,622.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,781.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,960.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,011.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,960.30
|
| Rate for Payer: Zelis Auto |
$865.20
|
| Rate for Payer: Zelis Medicare |
$7,616.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,752.36
|
| Rate for Payer: Zelis Worker's Compensation |
$590.50
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
CPT 53430
|
| Hospital Charge Code |
6153430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$542.45 |
| Max. Negotiated Rate |
$1,887.65 |
| Rate for Payer: Cash Price |
$1,192.20
|
| Rate for Payer: Cigna Commercial |
$1,688.95
|
| Rate for Payer: First Health Commercial |
$1,788.30
|
| Rate for Payer: First Health Workers Compensation |
$767.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,788.30
|
| Rate for Payer: GEHA Commercial |
$1,390.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,788.30
|
| Rate for Payer: Multiplan All |
$1,808.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,390.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,788.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,887.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,490.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,847.91
|
| Rate for Payer: Zelis Auto |
$794.80
|
| Rate for Payer: Zelis Worker's Compensation |
$542.45
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$1,772.00
|
|
|
Service Code
|
CPT 54312
|
| Hospital Charge Code |
6154312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$483.76 |
| 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 |
$1,063.20
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$1,506.20
|
| Rate for Payer: First Health Commercial |
$1,594.80
|
| Rate for Payer: First Health Workers Compensation |
$684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,594.80
|
| Rate for Payer: GEHA Commercial |
$1,417.60
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,594.80
|
| 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 |
$1,612.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,240.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,594.80
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,683.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.00
|
| 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 |
$1,647.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$708.80
|
| 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 |
$483.76
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$2,017.00
|
|
|
Service Code
|
CPT 53410
|
| Hospital Charge Code |
6153410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$550.64 |
| Max. Negotiated Rate |
$9,851.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,210.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,925.93
|
| Rate for Payer: Cash Price |
$1,210.20
|
| Rate for Payer: Cash Price |
$1,210.20
|
| Rate for Payer: Cigna Commercial |
$1,714.45
|
| Rate for Payer: First Health Commercial |
$1,815.30
|
| Rate for Payer: First Health Workers Compensation |
$778.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,815.30
|
| Rate for Payer: GEHA Commercial |
$1,613.60
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,815.30
|
| Rate for Payer: Humana ChoiceCare |
$5,418.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,925.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,275.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,925.93
|
| Rate for Payer: Multiplan All |
$1,835.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,411.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,815.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,925.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,916.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,512.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,827.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,925.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,875.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$806.80
|
| Rate for Payer: Zelis Medicare |
$4,187.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,911.12
|
| Rate for Payer: Zelis Worker's Compensation |
$550.64
|
|
|
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 |
$6,683.96 |
| 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 |
$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 |
$3,341.98
|
| 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 |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,755.00
|
| 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 |
$1,774.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,852.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,462.50
|
| 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 |
$1,813.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$780.00
|
| 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 |
$532.35
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 54318
|
| Hospital Charge Code |
6154318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.15 |
| Max. Negotiated Rate |
$1,462.05 |
| 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 |
$1,077.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,385.10
|
| Rate for Payer: Multiplan All |
$1,400.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,077.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,385.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,462.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,154.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,431.27
|
| Rate for Payer: Zelis Auto |
$615.60
|
| Rate for Payer: Zelis Worker's Compensation |
$420.15
|
|
|
RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKIN GRAFT(S), EACH WEB
|
Facility
|
OP
|
$3,101.54
|
|
|
Service Code
|
CPT 28345
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,318.15 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: First Health Workers Compensation |
$1,995.84
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$1,411.20
|
|
|
RECONSTRUCTION TONGUE FOLD
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 41520
|
| Hospital Charge Code |
6141520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$466.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
RECONSTRUCTION TONGUE FOLD
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 41520
|
| Hospital Charge Code |
6141520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$6,284.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$400.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,142.47
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$533.60
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| 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 |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$266.80
|
| 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 |
$182.09
|
|
|
RECONSTRUCT LARYNX & PHARYNX
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
CPT 31395
|
| Hospital Charge Code |
6131395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,574.50 |
| Max. Negotiated Rate |
$5,983.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,778.80
|
| Rate for Payer: Cash Price |
$3,778.80
|
| Rate for Payer: Cigna Commercial |
$5,353.30
|
| Rate for Payer: First Health Commercial |
$5,668.20
|
| Rate for Payer: First Health Workers Compensation |
$2,431.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,668.20
|
| Rate for Payer: GEHA Commercial |
$5,038.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,668.20
|
| Rate for Payer: Humana ChoiceCare |
$1,637.48
|
| Rate for Payer: Multiplan All |
$5,731.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,778.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,408.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,668.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,983.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,723.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,542.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,574.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,857.14
|
| Rate for Payer: Zelis Auto |
$2,519.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,149.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,719.35
|
|
|
RECONSTRUCT LARYNX & PHARYNX
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
CPT 31395
|
| Hospital Charge Code |
6131395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,719.35 |
| Max. Negotiated Rate |
$5,983.10 |
| Rate for Payer: Cash Price |
$3,778.80
|
| Rate for Payer: Cigna Commercial |
$5,353.30
|
| Rate for Payer: First Health Commercial |
$5,668.20
|
| Rate for Payer: First Health Workers Compensation |
$2,431.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,668.20
|
| Rate for Payer: GEHA Commercial |
$4,408.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,668.20
|
| Rate for Payer: Multiplan All |
$5,731.18
|
| Rate for Payer: OMNI Networks Commercial |
$4,408.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,668.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,983.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,723.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,857.14
|
| Rate for Payer: Zelis Auto |
$2,519.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,719.35
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
IP
|
$2,483.00
|
|
|
Service Code
|
CPT 23470
|
| Hospital Charge Code |
6123470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.86 |
| Max. Negotiated Rate |
$2,358.85 |
| Rate for Payer: Cash Price |
$1,489.80
|
| Rate for Payer: Cigna Commercial |
$2,110.55
|
| Rate for Payer: First Health Commercial |
$2,234.70
|
| Rate for Payer: First Health Workers Compensation |
$958.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,234.70
|
| Rate for Payer: GEHA Commercial |
$1,738.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,234.70
|
| Rate for Payer: Multiplan All |
$2,259.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,738.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,234.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,358.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,862.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,309.19
|
| Rate for Payer: Zelis Auto |
$993.20
|
| Rate for Payer: Zelis Worker's Compensation |
$677.86
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
OP
|
$2,483.00
|
|
|
Service Code
|
CPT 23470
|
| Hospital Charge Code |
6123470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.86 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,489.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,513.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,489.80
|
| Rate for Payer: Cash Price |
$1,489.80
|
| Rate for Payer: Cigna Commercial |
$2,110.55
|
| Rate for Payer: First Health Commercial |
$2,234.70
|
| Rate for Payer: First Health Workers Compensation |
$958.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,234.70
|
| Rate for Payer: GEHA Commercial |
$1,986.40
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,234.70
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$2,259.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,738.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,234.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11,207.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,706.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,358.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,862.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,309.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$993.20
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$677.86
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
OP
|
$3,012.00
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
6123472
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.28 |
| Max. Negotiated Rate |
$35,639.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26,634.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,807.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26,634.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21,099.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,819.59
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cigna Commercial |
$2,560.20
|
| Rate for Payer: First Health Commercial |
$2,710.80
|
| Rate for Payer: First Health Workers Compensation |
$1,162.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,710.80
|
| Rate for Payer: GEHA Commercial |
$2,409.60
|
| Rate for Payer: GEHA Medicare |
$17,819.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,710.80
|
| Rate for Payer: Humana ChoiceCare |
$19,601.55
|
| Rate for Payer: Humana Medicare Advantage |
$17,819.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,936.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21,529.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,819.59
|
| Rate for Payer: Multiplan All |
$2,740.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30,293.30
|
| Rate for Payer: OMNI Networks Commercial |
$2,108.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,710.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24,858.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21,529.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,819.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,861.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35,639.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,259.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,463.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21,529.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,819.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,801.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,819.59
|
| Rate for Payer: Zelis Auto |
$1,204.80
|
| Rate for Payer: Zelis Medicare |
$15,146.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21,383.51
|
| Rate for Payer: Zelis Worker's Compensation |
$822.28
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
IP
|
$3,012.00
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
6123472
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.28 |
| Max. Negotiated Rate |
$2,861.40 |
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cigna Commercial |
$2,560.20
|
| Rate for Payer: First Health Commercial |
$2,710.80
|
| Rate for Payer: First Health Workers Compensation |
$1,162.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,710.80
|
| Rate for Payer: GEHA Commercial |
$2,108.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,710.80
|
| Rate for Payer: Multiplan All |
$2,740.92
|
| Rate for Payer: OMNI Networks Commercial |
$2,108.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,710.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,861.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,259.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,801.16
|
| Rate for Payer: Zelis Auto |
$1,204.80
|
| Rate for Payer: Zelis Worker's Compensation |
$822.28
|
|
|
RECONSTRUCT ULNA/RADIOULNAR
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
CPT 25337
|
| Hospital Charge Code |
6125337
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.86 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cigna Commercial |
$1,537.65
|
| Rate for Payer: First Health Commercial |
$1,628.10
|
| Rate for Payer: First Health Workers Compensation |
$698.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,628.10
|
| Rate for Payer: GEHA Commercial |
$1,266.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,628.10
|
| Rate for Payer: Multiplan All |
$1,646.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,266.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,628.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,718.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,356.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,682.37
|
| Rate for Payer: Zelis Auto |
$723.60
|
| Rate for Payer: Zelis Worker's Compensation |
$493.86
|
|
|
RECONSTRUCT ULNA/RADIOULNAR
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
CPT 25337
|
| Hospital Charge Code |
6125337
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.86 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,085.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cigna Commercial |
$1,537.65
|
| Rate for Payer: First Health Commercial |
$1,628.10
|
| Rate for Payer: First Health Workers Compensation |
$698.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,628.10
|
| Rate for Payer: GEHA Commercial |
$1,447.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,628.10
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,646.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,266.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,628.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,718.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,356.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,682.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$723.60
|
| 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 |
$493.86
|
|
|
RECONSTRUCT URETHRA/BLADDER
|
Facility
|
OP
|
$2,392.00
|
|
|
Service Code
|
CPT 53431
|
| Hospital Charge Code |
6153431
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$653.02 |
| Max. Negotiated Rate |
$9,851.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,435.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,925.93
|
| Rate for Payer: Cash Price |
$1,435.20
|
| Rate for Payer: Cash Price |
$1,435.20
|
| Rate for Payer: Cigna Commercial |
$2,033.20
|
| Rate for Payer: First Health Commercial |
$2,152.80
|
| Rate for Payer: First Health Workers Compensation |
$923.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,152.80
|
| Rate for Payer: GEHA Commercial |
$1,913.60
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,152.80
|
| Rate for Payer: Humana ChoiceCare |
$5,418.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,925.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,275.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,925.93
|
| Rate for Payer: Multiplan All |
$2,176.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,674.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,152.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,925.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,272.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,794.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,827.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,925.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,224.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$956.80
|
| Rate for Payer: Zelis Medicare |
$4,187.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,911.12
|
| Rate for Payer: Zelis Worker's Compensation |
$653.02
|
|
|
RECONSTRUCT URETHRA/BLADDER
|
Facility
|
IP
|
$2,392.00
|
|
|
Service Code
|
CPT 53431
|
| Hospital Charge Code |
6153431
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$653.02 |
| Max. Negotiated Rate |
$2,272.40 |
| Rate for Payer: Cash Price |
$1,435.20
|
| Rate for Payer: Cigna Commercial |
$2,033.20
|
| Rate for Payer: First Health Commercial |
$2,152.80
|
| Rate for Payer: First Health Workers Compensation |
$923.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,152.80
|
| Rate for Payer: GEHA Commercial |
$1,674.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,152.80
|
| Rate for Payer: Multiplan All |
$2,176.72
|
| Rate for Payer: OMNI Networks Commercial |
$1,674.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,152.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,272.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,794.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,224.56
|
| Rate for Payer: Zelis Auto |
$956.80
|
| Rate for Payer: Zelis Worker's Compensation |
$653.02
|
|
|
RECONSTRUCT URETHRA/PENIS
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
CPT 54352
|
| Hospital Charge Code |
6154352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$798.80 |
| Max. Negotiated Rate |
$9,851.86 |
| 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 |
$1,755.60
|
| 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 |
$4,925.93
|
| Rate for Payer: Cash Price |
$1,755.60
|
| Rate for Payer: Cash Price |
$1,755.60
|
| Rate for Payer: Cigna Commercial |
$2,487.10
|
| Rate for Payer: First Health Commercial |
$2,633.40
|
| Rate for Payer: First Health Workers Compensation |
$1,129.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,633.40
|
| Rate for Payer: GEHA Commercial |
$2,340.80
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,633.40
|
| Rate for Payer: Humana ChoiceCare |
$5,418.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,925.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,275.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,925.93
|
| Rate for Payer: Multiplan All |
$2,662.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$2,048.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,633.40
|
| 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 |
$4,925.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,779.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$2,194.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,827.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,925.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,721.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$1,170.40
|
| Rate for Payer: Zelis Medicare |
$4,187.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,911.12
|
| Rate for Payer: Zelis Worker's Compensation |
$798.80
|
|
