|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 23415
|
| Hospital Charge Code |
6123415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$389.02 |
| Max. Negotiated Rate |
$1,353.75 |
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna Commercial |
$1,211.25
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: First Health Workers Compensation |
$550.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,282.50
|
| Rate for Payer: GEHA Commercial |
$997.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,282.50
|
| Rate for Payer: Multiplan All |
$1,296.75
|
| Rate for Payer: OMNI Networks Commercial |
$997.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,282.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,353.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,325.25
|
| Rate for Payer: Zelis Auto |
$570.00
|
| Rate for Payer: Zelis Worker's Compensation |
$389.02
|
|
|
RELEASE OF TOE JOINT EACH
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 28272
|
| Hospital Charge Code |
6128272
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.63 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$452.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$601.71
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
RELEASE OF TOE JOINT EACH
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 28272
|
| Hospital Charge Code |
6128272
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.63 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 Community HMO |
$388.20
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$517.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$601.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
RELEASE OF URETER
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
CPT 50722
|
| Hospital Charge Code |
6150722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.66 |
| Max. Negotiated Rate |
$1,999.75 |
| Rate for Payer: Cash Price |
$1,263.00
|
| Rate for Payer: Cigna Commercial |
$1,789.25
|
| Rate for Payer: First Health Commercial |
$1,894.50
|
| Rate for Payer: First Health Workers Compensation |
$812.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,894.50
|
| Rate for Payer: GEHA Commercial |
$1,473.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,894.50
|
| Rate for Payer: Multiplan All |
$1,915.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,473.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,894.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,999.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,578.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,957.65
|
| Rate for Payer: Zelis Auto |
$842.00
|
| Rate for Payer: Zelis Worker's Compensation |
$574.66
|
|
|
RELEASE OF URETER
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT 50722
|
| Hospital Charge Code |
6150722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$526.25 |
| Max. Negotiated Rate |
$1,999.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,263.00
|
| Rate for Payer: Cash Price |
$1,263.00
|
| Rate for Payer: Cigna Commercial |
$1,789.25
|
| Rate for Payer: First Health Commercial |
$1,894.50
|
| Rate for Payer: First Health Workers Compensation |
$812.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,894.50
|
| Rate for Payer: GEHA Commercial |
$1,684.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,894.50
|
| Rate for Payer: Humana ChoiceCare |
$547.30
|
| Rate for Payer: Multiplan All |
$1,915.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,263.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,473.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,894.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,999.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,578.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,852.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$526.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,957.65
|
| Rate for Payer: Zelis Auto |
$842.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,052.50
|
| Rate for Payer: Zelis Worker's Compensation |
$574.66
|
|
|
RELEASE OF URETER
|
Facility
|
IP
|
$2,538.00
|
|
|
Service Code
|
CPT 50715
|
| Hospital Charge Code |
6150715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$692.87 |
| Max. Negotiated Rate |
$2,411.10 |
| Rate for Payer: Cash Price |
$1,522.80
|
| Rate for Payer: Cigna Commercial |
$2,157.30
|
| Rate for Payer: First Health Commercial |
$2,284.20
|
| Rate for Payer: First Health Workers Compensation |
$979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,284.20
|
| Rate for Payer: GEHA Commercial |
$1,776.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,284.20
|
| Rate for Payer: Multiplan All |
$2,309.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,776.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,284.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,411.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,903.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,360.34
|
| Rate for Payer: Zelis Auto |
$1,015.20
|
| Rate for Payer: Zelis Worker's Compensation |
$692.87
|
|
|
RELEASE OF URETER
|
Facility
|
OP
|
$2,538.00
|
|
|
Service Code
|
CPT 50715
|
| Hospital Charge Code |
6150715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$634.50 |
| Max. Negotiated Rate |
$2,411.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,522.80
|
| Rate for Payer: Cash Price |
$1,522.80
|
| Rate for Payer: Cigna Commercial |
$2,157.30
|
| Rate for Payer: First Health Commercial |
$2,284.20
|
| Rate for Payer: First Health Workers Compensation |
$979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,284.20
|
| Rate for Payer: GEHA Commercial |
$2,030.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,284.20
|
| Rate for Payer: Humana ChoiceCare |
$659.88
|
| Rate for Payer: Multiplan All |
$2,309.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,522.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,776.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,284.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,411.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,903.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,233.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$634.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,360.34
|
| Rate for Payer: Zelis Auto |
$1,015.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,269.00
|
| Rate for Payer: Zelis Worker's Compensation |
$692.87
|
|
|
RELEASE OF URETER
|
Facility
|
OP
|
$1,827.00
|
|
|
Service Code
|
CPT 50940
|
| Hospital Charge Code |
6150940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$456.75 |
| Max. Negotiated Rate |
$1,735.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,096.20
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Cigna Commercial |
$1,552.95
|
| Rate for Payer: First Health Commercial |
$1,644.30
|
| Rate for Payer: First Health Workers Compensation |
$705.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,644.30
|
| Rate for Payer: GEHA Commercial |
$1,461.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,644.30
|
| Rate for Payer: Humana ChoiceCare |
$475.02
|
| Rate for Payer: Multiplan All |
$1,662.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,096.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,278.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,644.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,735.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,370.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,607.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,699.11
|
| Rate for Payer: Zelis Auto |
$730.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$913.50
|
| Rate for Payer: Zelis Worker's Compensation |
$498.77
|
|
|
RELEASE OF URETER
|
Facility
|
IP
|
$1,827.00
|
|
|
Service Code
|
CPT 50940
|
| Hospital Charge Code |
6150940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$498.77 |
| Max. Negotiated Rate |
$1,735.65 |
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Cigna Commercial |
$1,552.95
|
| Rate for Payer: First Health Commercial |
$1,644.30
|
| Rate for Payer: First Health Workers Compensation |
$705.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,644.30
|
| Rate for Payer: GEHA Commercial |
$1,278.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,644.30
|
| Rate for Payer: Multiplan All |
$1,662.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,278.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,644.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,735.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,370.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,699.11
|
| Rate for Payer: Zelis Auto |
$730.80
|
| Rate for Payer: Zelis Worker's Compensation |
$498.77
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$1,213.00
|
|
|
Service Code
|
CPT 26121
|
| Hospital Charge Code |
6126121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.15 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$727.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cigna Commercial |
$1,031.05
|
| Rate for Payer: First Health Commercial |
$1,091.70
|
| Rate for Payer: First Health Workers Compensation |
$468.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,091.70
|
| Rate for Payer: GEHA Commercial |
$970.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,091.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,103.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$849.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,091.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,152.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$909.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,128.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$485.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$331.15
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
6126123
|
|
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
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 26040
|
| Hospital Charge Code |
6126040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$213.49 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: First Health Workers Compensation |
$301.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$547.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: Zelis Auto |
$312.80
|
| Rate for Payer: Zelis Worker's Compensation |
$213.49
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT 26121
|
| Hospital Charge Code |
6126121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.15 |
| Max. Negotiated Rate |
$1,152.35 |
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cigna Commercial |
$1,031.05
|
| Rate for Payer: First Health Commercial |
$1,091.70
|
| Rate for Payer: First Health Workers Compensation |
$468.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,091.70
|
| Rate for Payer: GEHA Commercial |
$849.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,091.70
|
| Rate for Payer: Multiplan All |
$1,103.83
|
| Rate for Payer: OMNI Networks Commercial |
$849.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,091.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,152.35
|
| Rate for Payer: Three Rivers Provider Network All |
$909.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,128.09
|
| Rate for Payer: Zelis Auto |
$485.20
|
| Rate for Payer: Zelis Worker's Compensation |
$331.15
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
6126123
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| 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 |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| 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 |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 26125
|
| Hospital Charge Code |
6126125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$606.90
|
| Rate for Payer: First Health Commercial |
$642.60
|
| Rate for Payer: First Health Workers Compensation |
$275.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$642.60
|
| Rate for Payer: GEHA Commercial |
$499.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$642.60
|
| Rate for Payer: Multiplan All |
$649.74
|
| Rate for Payer: OMNI Networks Commercial |
$499.80
|
| Rate for Payer: One Health Plan PPO/POS |
$642.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$678.30
|
| Rate for Payer: Three Rivers Provider Network All |
$535.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.02
|
| Rate for Payer: Zelis Auto |
$285.60
|
| Rate for Payer: Zelis Worker's Compensation |
$194.92
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 26040
|
| Hospital Charge Code |
6126040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$213.49 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$469.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: First Health Workers Compensation |
$301.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$625.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$312.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$213.49
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 26045
|
| Hospital Charge Code |
6126045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.35 |
| Max. Negotiated Rate |
$902.50 |
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: First Health Workers Compensation |
$366.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.00
|
| Rate for Payer: GEHA Commercial |
$665.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.00
|
| Rate for Payer: Multiplan All |
$864.50
|
| Rate for Payer: OMNI Networks Commercial |
$665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$855.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$902.50
|
| Rate for Payer: Three Rivers Provider Network All |
$712.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$883.50
|
| Rate for Payer: Zelis Auto |
$380.00
|
| Rate for Payer: Zelis Worker's Compensation |
$259.35
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 26045
|
| Hospital Charge Code |
6126045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.35 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: First Health Workers Compensation |
$366.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.00
|
| Rate for Payer: GEHA Commercial |
$760.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$864.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$855.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$902.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$712.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$883.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$380.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$259.35
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 26125
|
| Hospital Charge Code |
6126125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$185.64 |
| Max. Negotiated Rate |
$1,723.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$606.90
|
| Rate for Payer: First Health Commercial |
$642.60
|
| Rate for Payer: First Health Workers Compensation |
$275.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$642.60
|
| Rate for Payer: GEHA Commercial |
$571.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$642.60
|
| Rate for Payer: Humana ChoiceCare |
$185.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Multiplan All |
$649.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.40
|
| Rate for Payer: OMNI Networks Commercial |
$499.80
|
| Rate for Payer: One Health Plan PPO/POS |
$642.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$678.30
|
| Rate for Payer: Three Rivers Provider Network All |
$535.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$628.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.02
|
| Rate for Payer: Zelis Auto |
$285.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$357.00
|
| Rate for Payer: Zelis Worker's Compensation |
$194.92
|
|
|
RELEASE PALM & FINGER TENDON
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 26442
|
| Hospital Charge Code |
6126442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$1,618.40
|
| Rate for Payer: First Health Commercial |
$1,713.60
|
| Rate for Payer: First Health Workers Compensation |
$735.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,713.60
|
| Rate for Payer: GEHA Commercial |
$1,523.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,713.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,732.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,332.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,713.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,808.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,428.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,770.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$761.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$519.79
|
|
|
RELEASE PALM & FINGER TENDON
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 26442
|
| Hospital Charge Code |
6126442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$1,808.80 |
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$1,618.40
|
| Rate for Payer: First Health Commercial |
$1,713.60
|
| Rate for Payer: First Health Workers Compensation |
$735.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,713.60
|
| Rate for Payer: GEHA Commercial |
$1,332.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,713.60
|
| Rate for Payer: Multiplan All |
$1,732.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,332.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,713.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,808.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,428.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,770.72
|
| Rate for Payer: Zelis Auto |
$761.60
|
| Rate for Payer: Zelis Worker's Compensation |
$519.79
|
|
|
RELEASE PALM/FINGER TENDON
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 26440
|
| Hospital Charge Code |
6126440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$846.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
RELEASE PALM/FINGER TENDON
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 26440
|
| Hospital Charge Code |
6126440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$967.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
RELEASE/REVISE URETER
|
Facility
|
IP
|
$2,337.00
|
|
|
Service Code
|
CPT 50725
|
| Hospital Charge Code |
6150725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$2,220.15 |
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cigna Commercial |
$1,986.45
|
| Rate for Payer: First Health Commercial |
$2,103.30
|
| Rate for Payer: First Health Workers Compensation |
$902.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,103.30
|
| Rate for Payer: GEHA Commercial |
$1,635.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,103.30
|
| Rate for Payer: Multiplan All |
$2,126.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,635.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,103.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,220.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,752.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,173.41
|
| Rate for Payer: Zelis Auto |
$934.80
|
| Rate for Payer: Zelis Worker's Compensation |
$638.00
|
|
|
RELEASE/REVISE URETER
|
Facility
|
OP
|
$2,337.00
|
|
|
Service Code
|
CPT 50725
|
| Hospital Charge Code |
6150725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.25 |
| Max. Negotiated Rate |
$2,220.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cigna Commercial |
$1,986.45
|
| Rate for Payer: First Health Commercial |
$2,103.30
|
| Rate for Payer: First Health Workers Compensation |
$902.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,103.30
|
| Rate for Payer: GEHA Commercial |
$1,869.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,103.30
|
| Rate for Payer: Humana ChoiceCare |
$607.62
|
| Rate for Payer: Multiplan All |
$2,126.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,402.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,635.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,103.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,220.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,752.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,056.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$584.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,173.41
|
| Rate for Payer: Zelis Auto |
$934.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,168.50
|
| Rate for Payer: Zelis Worker's Compensation |
$638.00
|
|
