|
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 |
$9,654.20 |
| 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 |
$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 |
$4,827.10
|
| 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 |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,633.40
|
| 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 |
$2,662.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| 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 |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,779.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,194.50
|
| 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 |
$2,721.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$1,170.40
|
| 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 |
$798.80
|
|
|
RECONSTRUCT URETHRA STAGE 1
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
CPT 53420
|
| Hospital Charge Code |
6153420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.21 |
| Max. Negotiated Rate |
$1,671.05 |
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$1,495.15
|
| Rate for Payer: First Health Commercial |
$1,583.10
|
| Rate for Payer: First Health Workers Compensation |
$679.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,583.10
|
| Rate for Payer: GEHA Commercial |
$1,231.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,583.10
|
| Rate for Payer: Multiplan All |
$1,600.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,231.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,583.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,671.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,319.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,635.87
|
| Rate for Payer: Zelis Auto |
$703.60
|
| Rate for Payer: Zelis Worker's Compensation |
$480.21
|
|
|
RECONSTRUCT URETHRA STAGE 1
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
CPT 53420
|
| Hospital Charge Code |
6153420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.21 |
| Max. Negotiated Rate |
$9,654.20 |
| 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 |
$1,055.40
|
| 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 |
$4,827.10
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$1,495.15
|
| Rate for Payer: First Health Commercial |
$1,583.10
|
| Rate for Payer: First Health Workers Compensation |
$679.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,583.10
|
| Rate for Payer: GEHA Commercial |
$1,407.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,583.10
|
| 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 |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,600.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,231.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,583.10
|
| 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 |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,671.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,319.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,635.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$703.60
|
| 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 |
$480.21
|
|
|
RECONSTRUCT URETHRA STAGE 2
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT 53425
|
| Hospital Charge Code |
6153425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.71 |
| Max. Negotiated Rate |
$1,836.35 |
| Rate for Payer: Cash Price |
$1,159.80
|
| Rate for Payer: Cigna Commercial |
$1,643.05
|
| Rate for Payer: First Health Commercial |
$1,739.70
|
| Rate for Payer: First Health Workers Compensation |
$746.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,739.70
|
| Rate for Payer: GEHA Commercial |
$1,353.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,739.70
|
| Rate for Payer: Multiplan All |
$1,759.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,353.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,739.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,836.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,797.69
|
| Rate for Payer: Zelis Auto |
$773.20
|
| Rate for Payer: Zelis Worker's Compensation |
$527.71
|
|
|
RECONSTRUCT URETHRA STAGE 2
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT 53425
|
| Hospital Charge Code |
6153425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.71 |
| Max. Negotiated Rate |
$9,654.20 |
| 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 |
$1,159.80
|
| 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 |
$4,827.10
|
| Rate for Payer: Cash Price |
$1,159.80
|
| Rate for Payer: Cash Price |
$1,159.80
|
| Rate for Payer: Cigna Commercial |
$1,643.05
|
| Rate for Payer: First Health Commercial |
$1,739.70
|
| Rate for Payer: First Health Workers Compensation |
$746.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,739.70
|
| Rate for Payer: GEHA Commercial |
$1,546.40
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,739.70
|
| 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 |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,759.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,353.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,739.70
|
| 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 |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,836.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,797.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$773.20
|
| 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 |
$527.71
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 25443
|
| Hospital Charge Code |
6125443
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$437.35 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$961.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,652.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$961.20
|
| Rate for Payer: Cash Price |
$961.20
|
| Rate for Payer: Cigna Commercial |
$1,361.70
|
| Rate for Payer: First Health Commercial |
$1,441.80
|
| Rate for Payer: First Health Workers Compensation |
$618.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,441.80
|
| Rate for Payer: GEHA Commercial |
$1,281.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,441.80
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,747.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,457.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,121.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,441.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,481.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,747.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,521.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,201.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,747.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,489.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$640.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$437.35
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 25444
|
| Hospital Charge Code |
6125444
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,017.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,652.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,356.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,747.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,481.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,747.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,747.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 25444
|
| Hospital Charge Code |
6125444
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$1,610.25 |
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,186.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT 25442
|
| Hospital Charge Code |
6125442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$448.54 |
| Max. Negotiated Rate |
$34,924.18 |
| 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 |
$985.80
|
| 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 |
$17,462.09
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna Commercial |
$1,396.55
|
| Rate for Payer: First Health Commercial |
$1,478.70
|
| Rate for Payer: First Health Workers Compensation |
$634.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,478.70
|
| Rate for Payer: GEHA Commercial |
$1,314.40
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,478.70
|
| 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 |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$1,495.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,478.70
|
| 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 |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,560.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,232.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,527.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$657.20
|
| 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 |
$448.54
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
CPT 25445
|
| Hospital Charge Code |
6125445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.68 |
| Max. Negotiated Rate |
$1,401.25 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,253.75
|
| Rate for Payer: First Health Commercial |
$1,327.50
|
| Rate for Payer: First Health Workers Compensation |
$569.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,327.50
|
| Rate for Payer: GEHA Commercial |
$1,032.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,327.50
|
| Rate for Payer: Multiplan All |
$1,342.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,032.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,327.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,401.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,106.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,371.75
|
| Rate for Payer: Zelis Auto |
$590.00
|
| Rate for Payer: Zelis Worker's Compensation |
$402.68
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT 25442
|
| Hospital Charge Code |
6125442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$448.54 |
| Max. Negotiated Rate |
$1,560.85 |
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna Commercial |
$1,396.55
|
| Rate for Payer: First Health Commercial |
$1,478.70
|
| Rate for Payer: First Health Workers Compensation |
$634.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,478.70
|
| Rate for Payer: GEHA Commercial |
$1,150.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,478.70
|
| Rate for Payer: Multiplan All |
$1,495.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,478.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,560.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,232.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,527.99
|
| Rate for Payer: Zelis Auto |
$657.20
|
| Rate for Payer: Zelis Worker's Compensation |
$448.54
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
CPT 25441
|
| Hospital Charge Code |
6125441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.07 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,143.00
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cigna Commercial |
$1,619.25
|
| Rate for Payer: First Health Commercial |
$1,714.50
|
| Rate for Payer: First Health Workers Compensation |
$735.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,714.50
|
| Rate for Payer: GEHA Commercial |
$1,524.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,714.50
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,733.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,333.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,714.50
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,809.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,428.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,771.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$762.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$520.07
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
CPT 25441
|
| Hospital Charge Code |
6125441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.07 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cigna Commercial |
$1,619.25
|
| Rate for Payer: First Health Commercial |
$1,714.50
|
| Rate for Payer: First Health Workers Compensation |
$735.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,714.50
|
| Rate for Payer: GEHA Commercial |
$1,333.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,714.50
|
| Rate for Payer: Multiplan All |
$1,733.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,333.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,714.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,809.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,428.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,771.65
|
| Rate for Payer: Zelis Auto |
$762.00
|
| Rate for Payer: Zelis Worker's Compensation |
$520.07
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
CPT 25445
|
| Hospital Charge Code |
6125445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.68 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,652.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,253.75
|
| Rate for Payer: First Health Commercial |
$1,327.50
|
| Rate for Payer: First Health Workers Compensation |
$569.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,327.50
|
| Rate for Payer: GEHA Commercial |
$1,180.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,327.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,747.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,342.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,032.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,327.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,481.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,747.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,401.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,106.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,747.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,371.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$590.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$402.68
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 25443
|
| Hospital Charge Code |
6125443
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$437.35 |
| Max. Negotiated Rate |
$1,521.90 |
| Rate for Payer: Cash Price |
$961.20
|
| Rate for Payer: Cigna Commercial |
$1,361.70
|
| Rate for Payer: First Health Commercial |
$1,441.80
|
| Rate for Payer: First Health Workers Compensation |
$618.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,441.80
|
| Rate for Payer: GEHA Commercial |
$1,121.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,441.80
|
| Rate for Payer: Multiplan All |
$1,457.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,121.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,441.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,521.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,201.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,489.86
|
| Rate for Payer: Zelis Auto |
$640.80
|
| Rate for Payer: Zelis Worker's Compensation |
$437.35
|
|
|
REDO ENDOVAS VENA CAVA FILTR
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
6137192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$308.22 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,066.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$677.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,066.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,429.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cigna Commercial |
$959.65
|
| Rate for Payer: First Health Commercial |
$1,016.10
|
| Rate for Payer: First Health Workers Compensation |
$435.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,016.10
|
| Rate for Payer: GEHA Commercial |
$903.20
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,016.10
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,478.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,027.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$790.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,016.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,862.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,478.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,072.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$846.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,478.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$451.60
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$308.22
|
|
|
REDO ENDOVAS VENA CAVA FILTR
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
6137192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$308.22 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cigna Commercial |
$959.65
|
| Rate for Payer: First Health Commercial |
$1,016.10
|
| Rate for Payer: First Health Workers Compensation |
$435.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,016.10
|
| Rate for Payer: GEHA Commercial |
$790.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,016.10
|
| Rate for Payer: Multiplan All |
$1,027.39
|
| Rate for Payer: OMNI Networks Commercial |
$790.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,016.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,072.55
|
| Rate for Payer: Three Rivers Provider Network All |
$846.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.97
|
| Rate for Payer: Zelis Auto |
$451.60
|
| Rate for Payer: Zelis Worker's Compensation |
$308.22
|
|
|
RED TAG BLOOD CELL
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
2410058
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$170.90 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$532.10
|
| Rate for Payer: First Health Commercial |
$563.40
|
| Rate for Payer: First Health Workers Compensation |
$241.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$563.40
|
| Rate for Payer: GEHA Commercial |
$438.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$563.40
|
| Rate for Payer: Multiplan All |
$569.66
|
| Rate for Payer: OMNI Networks Commercial |
$438.20
|
| Rate for Payer: One Health Plan PPO/POS |
$563.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$594.70
|
| Rate for Payer: Three Rivers Provider Network All |
$469.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$582.18
|
| Rate for Payer: Zelis Auto |
$250.40
|
| Rate for Payer: Zelis Worker's Compensation |
$170.90
|
|
|
RED TAG BLOOD CELL
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
2410058
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$156.50 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$532.10
|
| Rate for Payer: First Health Commercial |
$563.40
|
| Rate for Payer: First Health Workers Compensation |
$241.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$563.40
|
| Rate for Payer: GEHA Commercial |
$500.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$563.40
|
| Rate for Payer: Humana ChoiceCare |
$162.76
|
| Rate for Payer: Multiplan All |
$569.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.60
|
| Rate for Payer: OMNI Networks Commercial |
$438.20
|
| Rate for Payer: One Health Plan PPO/POS |
$563.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$594.70
|
| Rate for Payer: Three Rivers Provider Network All |
$469.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$582.18
|
| Rate for Payer: Zelis Auto |
$250.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$313.00
|
| Rate for Payer: Zelis Worker's Compensation |
$170.90
|
|
|
REDUCE BOWEL OBSTRUCTION
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 44050
|
| Hospital Charge Code |
6144050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$492.25 |
| Max. Negotiated Rate |
$1,870.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,181.40
|
| Rate for Payer: Cash Price |
$1,181.40
|
| Rate for Payer: Cigna Commercial |
$1,673.65
|
| Rate for Payer: First Health Commercial |
$1,772.10
|
| Rate for Payer: First Health Workers Compensation |
$760.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,772.10
|
| Rate for Payer: GEHA Commercial |
$1,575.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,772.10
|
| Rate for Payer: Humana ChoiceCare |
$511.94
|
| Rate for Payer: Multiplan All |
$1,791.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,181.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,378.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,772.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,870.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,476.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,732.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$492.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,831.17
|
| Rate for Payer: Zelis Auto |
$787.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$984.50
|
| Rate for Payer: Zelis Worker's Compensation |
$537.54
|
|
|
REDUCE BOWEL OBSTRUCTION
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 44050
|
| Hospital Charge Code |
6144050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.54 |
| Max. Negotiated Rate |
$1,870.55 |
| Rate for Payer: Cash Price |
$1,181.40
|
| Rate for Payer: Cigna Commercial |
$1,673.65
|
| Rate for Payer: First Health Commercial |
$1,772.10
|
| Rate for Payer: First Health Workers Compensation |
$760.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,772.10
|
| Rate for Payer: GEHA Commercial |
$1,378.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,772.10
|
| Rate for Payer: Multiplan All |
$1,791.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,378.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,772.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,870.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,476.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,831.17
|
| Rate for Payer: Zelis Auto |
$787.60
|
| Rate for Payer: Zelis Worker's Compensation |
$537.54
|
|
|
REDUCE TESTIS TORSION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
CPT 54600
|
| Hospital Charge Code |
6154600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.25 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: First Health Workers Compensation |
$361.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$654.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Worker's Compensation |
$255.25
|
|
|
REDUCE TESTIS TORSION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
CPT 54600
|
| Hospital Charge Code |
6154600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.25 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: First Health Workers Compensation |
$361.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$748.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| 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 |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$374.00
|
| 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 |
$255.25
|
|
|
REDUCT ELBOW DISLOC;ADULT
|
Facility
|
IP
|
$1,373.00
|
|
| Hospital Charge Code |
8150080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.83 |
| Max. Negotiated Rate |
$1,304.35 |
| Rate for Payer: Cash Price |
$823.80
|
| Rate for Payer: Cigna Commercial |
$1,167.05
|
| Rate for Payer: First Health Commercial |
$1,235.70
|
| Rate for Payer: First Health Workers Compensation |
$530.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,235.70
|
| Rate for Payer: GEHA Commercial |
$961.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,235.70
|
| Rate for Payer: Multiplan All |
$1,249.43
|
| Rate for Payer: OMNI Networks Commercial |
$961.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,235.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,304.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.89
|
| Rate for Payer: Zelis Auto |
$549.20
|
| Rate for Payer: Zelis Worker's Compensation |
$374.83
|
|
|
REDUCT ELBOW DISLOC;ADULT
|
Facility
|
OP
|
$1,373.00
|
|
| Hospital Charge Code |
8150080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$1,304.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$823.80
|
| Rate for Payer: Cash Price |
$823.80
|
| Rate for Payer: Cigna Commercial |
$1,167.05
|
| Rate for Payer: First Health Commercial |
$1,235.70
|
| Rate for Payer: First Health Workers Compensation |
$530.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,235.70
|
| Rate for Payer: GEHA Commercial |
$1,098.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,235.70
|
| Rate for Payer: Humana ChoiceCare |
$356.98
|
| Rate for Payer: Multiplan All |
$1,249.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$823.80
|
| Rate for Payer: OMNI Networks Commercial |
$961.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,235.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,304.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,208.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$343.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.89
|
| Rate for Payer: Zelis Auto |
$549.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$686.50
|
| Rate for Payer: Zelis Worker's Compensation |
$374.83
|
|
