|
REMOVE RADIUS BONE LESION
|
Facility
|
OP
|
$1,273.00
|
|
|
Service Code
|
CPT 24136
|
| Hospital Charge Code |
6124136
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$763.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$1,018.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$509.20
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$347.53
|
|
|
REMOVE RADIUS BONE LESION
|
Facility
|
IP
|
$1,273.00
|
|
|
Service Code
|
CPT 24136
|
| Hospital Charge Code |
6124136
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$891.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: Zelis Auto |
$509.20
|
| Rate for Payer: Zelis Worker's Compensation |
$347.53
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 24164
|
| Hospital Charge Code |
6124164
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$898.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,198.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$599.20
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$408.95
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 24164
|
| Hospital Charge Code |
6124164
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$1,423.10 |
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,048.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: Zelis Auto |
$599.20
|
| Rate for Payer: Zelis Worker's Compensation |
$408.95
|
|
|
REMOVE RECTUM W/RESERVOIR
|
Facility
|
IP
|
$4,073.00
|
|
|
Service Code
|
CPT 45119
|
| Hospital Charge Code |
6145119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,111.93 |
| Max. Negotiated Rate |
$3,869.35 |
| Rate for Payer: Cash Price |
$2,443.80
|
| Rate for Payer: Cigna Commercial |
$3,462.05
|
| Rate for Payer: First Health Commercial |
$3,665.70
|
| Rate for Payer: First Health Workers Compensation |
$1,572.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,665.70
|
| Rate for Payer: GEHA Commercial |
$2,851.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,665.70
|
| Rate for Payer: Multiplan All |
$3,706.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,851.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,665.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,869.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,054.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,787.89
|
| Rate for Payer: Zelis Auto |
$1,629.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,111.93
|
|
|
REMOVE RECTUM W/RESERVOIR
|
Facility
|
OP
|
$4,073.00
|
|
|
Service Code
|
CPT 45119
|
| Hospital Charge Code |
6145119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,018.25 |
| Max. Negotiated Rate |
$3,869.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,443.80
|
| Rate for Payer: Cash Price |
$2,443.80
|
| Rate for Payer: Cigna Commercial |
$3,462.05
|
| Rate for Payer: First Health Commercial |
$3,665.70
|
| Rate for Payer: First Health Workers Compensation |
$1,572.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,665.70
|
| Rate for Payer: GEHA Commercial |
$3,258.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,665.70
|
| Rate for Payer: Humana ChoiceCare |
$1,058.98
|
| Rate for Payer: Multiplan All |
$3,706.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,443.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,851.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,665.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,869.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,054.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,584.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,018.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,787.89
|
| Rate for Payer: Zelis Auto |
$1,629.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,036.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,111.93
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 54410
|
| Hospital Charge Code |
6154410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.94 |
| Max. Negotiated Rate |
$1,680.55 |
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cigna Commercial |
$1,503.65
|
| Rate for Payer: First Health Commercial |
$1,592.10
|
| Rate for Payer: First Health Workers Compensation |
$683.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,592.10
|
| Rate for Payer: GEHA Commercial |
$1,238.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,592.10
|
| Rate for Payer: Multiplan All |
$1,609.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,238.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,592.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,680.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,645.17
|
| Rate for Payer: Zelis Auto |
$707.60
|
| Rate for Payer: Zelis Worker's Compensation |
$482.94
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
CPT 54410
|
| Hospital Charge Code |
6154410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.94 |
| Max. Negotiated Rate |
$39,008.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16,614.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,061.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16,614.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13,161.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,504.17
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cigna Commercial |
$1,503.65
|
| Rate for Payer: First Health Commercial |
$1,592.10
|
| Rate for Payer: First Health Workers Compensation |
$683.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,592.10
|
| Rate for Payer: GEHA Commercial |
$1,415.20
|
| Rate for Payer: GEHA Medicare |
$19,504.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,592.10
|
| Rate for Payer: Humana ChoiceCare |
$21,454.59
|
| Rate for Payer: Humana Medicare Advantage |
$19,504.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,767.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13,429.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,504.17
|
| Rate for Payer: Multiplan All |
$1,609.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33,157.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,238.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,592.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15,506.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13,429.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,504.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,680.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39,008.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,114.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13,429.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,504.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,645.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,504.17
|
| Rate for Payer: Zelis Auto |
$707.60
|
| Rate for Payer: Zelis Medicare |
$16,578.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23,405.00
|
| Rate for Payer: Zelis Worker's Compensation |
$482.94
|
|
|
REMOVE/REPLACE UR SPHINCTER
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT 53447
|
| Hospital Charge Code |
6153447
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.27 |
| Max. Negotiated Rate |
$39,008.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16,614.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$998.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16,614.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13,161.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,504.17
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$1,414.40
|
| Rate for Payer: First Health Commercial |
$1,497.60
|
| Rate for Payer: First Health Workers Compensation |
$642.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,497.60
|
| Rate for Payer: GEHA Commercial |
$1,331.20
|
| Rate for Payer: GEHA Medicare |
$19,504.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,497.60
|
| Rate for Payer: Humana ChoiceCare |
$21,454.59
|
| Rate for Payer: Humana Medicare Advantage |
$19,504.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,767.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13,429.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,504.17
|
| Rate for Payer: Multiplan All |
$1,514.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33,157.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,164.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,497.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15,506.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13,429.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,504.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,580.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39,008.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,114.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13,429.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,504.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,547.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,504.17
|
| Rate for Payer: Zelis Auto |
$665.60
|
| Rate for Payer: Zelis Medicare |
$16,578.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23,405.00
|
| Rate for Payer: Zelis Worker's Compensation |
$454.27
|
|
|
REMOVE/REPLACE UR SPHINCTER
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT 53447
|
| Hospital Charge Code |
6153447
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.27 |
| Max. Negotiated Rate |
$1,580.80 |
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$1,414.40
|
| Rate for Payer: First Health Commercial |
$1,497.60
|
| Rate for Payer: First Health Workers Compensation |
$642.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,497.60
|
| Rate for Payer: GEHA Commercial |
$1,164.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,497.60
|
| Rate for Payer: Multiplan All |
$1,514.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,164.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,497.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,580.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,547.52
|
| Rate for Payer: Zelis Auto |
$665.60
|
| Rate for Payer: Zelis Worker's Compensation |
$454.27
|
|
|
REMOVE/REVISE MALE SLING
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 53442
|
| Hospital Charge Code |
6153442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.98 |
| Max. Negotiated Rate |
$1,527.60 |
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Cigna Commercial |
$1,366.80
|
| Rate for Payer: First Health Commercial |
$1,447.20
|
| Rate for Payer: First Health Workers Compensation |
$620.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,447.20
|
| Rate for Payer: GEHA Commercial |
$1,125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,447.20
|
| Rate for Payer: Multiplan All |
$1,463.28
|
| Rate for Payer: OMNI Networks Commercial |
$1,125.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,447.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,527.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,206.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,495.44
|
| Rate for Payer: Zelis Auto |
$643.20
|
| Rate for Payer: Zelis Worker's Compensation |
$438.98
|
|
|
REMOVE/REVISE MALE SLING
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 53442
|
| Hospital Charge Code |
6153442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.98 |
| 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 |
$964.80
|
| 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 |
$4,925.93
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Cigna Commercial |
$1,366.80
|
| Rate for Payer: First Health Commercial |
$1,447.20
|
| Rate for Payer: First Health Workers Compensation |
$620.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,447.20
|
| Rate for Payer: GEHA Commercial |
$1,286.40
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,447.20
|
| 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 |
$1,463.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,125.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,447.20
|
| 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 |
$1,527.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,206.00
|
| 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 |
$1,495.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$643.20
|
| 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 |
$438.98
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
CPT 15936
|
| Hospital Charge Code |
6115936
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$500.41 |
| Max. Negotiated Rate |
$3,544.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,099.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,772.49
|
| Rate for Payer: Cash Price |
$1,099.80
|
| Rate for Payer: Cash Price |
$1,099.80
|
| Rate for Payer: Cigna Commercial |
$1,558.05
|
| Rate for Payer: First Health Commercial |
$1,649.70
|
| Rate for Payer: First Health Workers Compensation |
$707.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,649.70
|
| Rate for Payer: GEHA Commercial |
$1,466.40
|
| Rate for Payer: GEHA Medicare |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,649.70
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$1,668.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,283.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,649.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,741.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$1,374.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,704.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$733.20
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$500.41
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
CPT 15934
|
| Hospital Charge Code |
6115934
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$521.70 |
| Max. Negotiated Rate |
$1,815.45 |
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cigna Commercial |
$1,624.35
|
| Rate for Payer: First Health Commercial |
$1,719.90
|
| Rate for Payer: First Health Workers Compensation |
$737.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.90
|
| Rate for Payer: GEHA Commercial |
$1,337.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.90
|
| Rate for Payer: Multiplan All |
$1,739.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,815.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,433.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,777.23
|
| Rate for Payer: Zelis Auto |
$764.40
|
| Rate for Payer: Zelis Worker's Compensation |
$521.70
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
CPT 15935
|
| Hospital Charge Code |
6115935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$613.16 |
| Max. Negotiated Rate |
$2,133.70 |
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$1,909.10
|
| Rate for Payer: First Health Commercial |
$2,021.40
|
| Rate for Payer: First Health Workers Compensation |
$867.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,021.40
|
| Rate for Payer: GEHA Commercial |
$1,572.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,021.40
|
| Rate for Payer: Multiplan All |
$2,043.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,572.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,021.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,133.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,684.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,088.78
|
| Rate for Payer: Zelis Auto |
$898.40
|
| Rate for Payer: Zelis Worker's Compensation |
$613.16
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$2,123.00
|
|
|
Service Code
|
CPT 15937
|
| Hospital Charge Code |
6115937
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$579.58 |
| Max. Negotiated Rate |
$2,016.85 |
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cigna Commercial |
$1,804.55
|
| Rate for Payer: First Health Commercial |
$1,910.70
|
| Rate for Payer: First Health Workers Compensation |
$819.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,910.70
|
| Rate for Payer: GEHA Commercial |
$1,486.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,910.70
|
| Rate for Payer: Multiplan All |
$1,931.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,486.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,910.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,016.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,592.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,974.39
|
| Rate for Payer: Zelis Auto |
$849.20
|
| Rate for Payer: Zelis Worker's Compensation |
$579.58
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$1,738.00
|
|
|
Service Code
|
CPT 15933
|
| Hospital Charge Code |
6115933
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.47 |
| Max. Negotiated Rate |
$1,651.10 |
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: First Health Commercial |
$1,564.20
|
| Rate for Payer: First Health Workers Compensation |
$671.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,564.20
|
| Rate for Payer: GEHA Commercial |
$1,216.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,564.20
|
| Rate for Payer: Multiplan All |
$1,581.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,216.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,564.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,651.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,303.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,616.34
|
| Rate for Payer: Zelis Auto |
$695.20
|
| Rate for Payer: Zelis Worker's Compensation |
$474.47
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 15936
|
| Hospital Charge Code |
6115936
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$500.41 |
| Max. Negotiated Rate |
$1,741.35 |
| Rate for Payer: Cash Price |
$1,099.80
|
| Rate for Payer: Cigna Commercial |
$1,558.05
|
| Rate for Payer: First Health Commercial |
$1,649.70
|
| Rate for Payer: First Health Workers Compensation |
$707.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,649.70
|
| Rate for Payer: GEHA Commercial |
$1,283.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,649.70
|
| Rate for Payer: Multiplan All |
$1,668.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,283.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,649.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,741.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,374.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,704.69
|
| Rate for Payer: Zelis Auto |
$733.20
|
| Rate for Payer: Zelis Worker's Compensation |
$500.41
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
CPT 15935
|
| Hospital Charge Code |
6115935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$613.16 |
| Max. Negotiated Rate |
$7,094.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,347.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,547.41
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$1,909.10
|
| Rate for Payer: First Health Commercial |
$2,021.40
|
| Rate for Payer: First Health Workers Compensation |
$867.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,021.40
|
| Rate for Payer: GEHA Commercial |
$1,796.80
|
| Rate for Payer: GEHA Medicare |
$3,547.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,021.40
|
| Rate for Payer: Humana ChoiceCare |
$3,902.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,547.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,959.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,547.41
|
| Rate for Payer: Multiplan All |
$2,043.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,030.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,572.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,021.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,547.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,133.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,094.82
|
| Rate for Payer: Three Rivers Provider Network All |
$1,684.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,476.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,547.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,088.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,547.41
|
| Rate for Payer: Zelis Auto |
$898.40
|
| Rate for Payer: Zelis Medicare |
$3,015.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,256.89
|
| Rate for Payer: Zelis Worker's Compensation |
$613.16
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$1,738.00
|
|
|
Service Code
|
CPT 15933
|
| Hospital Charge Code |
6115933
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.47 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,042.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: First Health Commercial |
$1,564.20
|
| Rate for Payer: First Health Workers Compensation |
$671.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,564.20
|
| Rate for Payer: GEHA Commercial |
$1,390.40
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,564.20
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,581.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,216.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,564.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,651.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,303.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,616.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$695.20
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$474.47
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
CPT 15934
|
| Hospital Charge Code |
6115934
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$521.70 |
| Max. Negotiated Rate |
$7,094.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,146.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,547.41
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cigna Commercial |
$1,624.35
|
| Rate for Payer: First Health Commercial |
$1,719.90
|
| Rate for Payer: First Health Workers Compensation |
$737.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.90
|
| Rate for Payer: GEHA Commercial |
$1,528.80
|
| Rate for Payer: GEHA Medicare |
$3,547.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.90
|
| Rate for Payer: Humana ChoiceCare |
$3,902.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,547.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,959.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,547.41
|
| Rate for Payer: Multiplan All |
$1,739.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,030.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,547.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,815.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,094.82
|
| Rate for Payer: Three Rivers Provider Network All |
$1,433.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,476.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,547.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,777.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,547.41
|
| Rate for Payer: Zelis Auto |
$764.40
|
| Rate for Payer: Zelis Medicare |
$3,015.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,256.89
|
| Rate for Payer: Zelis Worker's Compensation |
$521.70
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$1,417.00
|
|
|
Service Code
|
CPT 15931
|
| Hospital Charge Code |
6115931
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$386.84 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$850.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cigna Commercial |
$1,204.45
|
| Rate for Payer: First Health Commercial |
$1,275.30
|
| Rate for Payer: First Health Workers Compensation |
$547.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,275.30
|
| Rate for Payer: GEHA Commercial |
$1,133.60
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,275.30
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,289.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$991.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,275.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,346.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,062.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,317.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$566.80
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$386.84
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$1,417.00
|
|
|
Service Code
|
CPT 15931
|
| Hospital Charge Code |
6115931
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$386.84 |
| Max. Negotiated Rate |
$1,346.15 |
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cigna Commercial |
$1,204.45
|
| Rate for Payer: First Health Commercial |
$1,275.30
|
| Rate for Payer: First Health Workers Compensation |
$547.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,275.30
|
| Rate for Payer: GEHA Commercial |
$991.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,275.30
|
| Rate for Payer: Multiplan All |
$1,289.47
|
| Rate for Payer: OMNI Networks Commercial |
$991.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,275.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,346.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,062.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,317.81
|
| Rate for Payer: Zelis Auto |
$566.80
|
| Rate for Payer: Zelis Worker's Compensation |
$386.84
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$2,123.00
|
|
|
Service Code
|
CPT 15937
|
| Hospital Charge Code |
6115937
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$579.58 |
| Max. Negotiated Rate |
$3,544.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,273.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,772.49
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cigna Commercial |
$1,804.55
|
| Rate for Payer: First Health Commercial |
$1,910.70
|
| Rate for Payer: First Health Workers Compensation |
$819.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,910.70
|
| Rate for Payer: GEHA Commercial |
$1,698.40
|
| Rate for Payer: GEHA Medicare |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,910.70
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$1,931.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,486.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,910.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,016.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$1,592.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,974.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$849.20
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$579.58
|
|
|
REMOVE SCIATIC NERVE LESION
|
Facility
|
OP
|
$2,221.00
|
|
|
Service Code
|
CPT 64786
|
| Hospital Charge Code |
6164786
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$606.33 |
| Max. Negotiated Rate |
$12,410.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,332.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,986.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,205.42
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$1,887.85
|
| Rate for Payer: First Health Commercial |
$1,998.90
|
| Rate for Payer: First Health Workers Compensation |
$857.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,998.90
|
| Rate for Payer: GEHA Commercial |
$1,776.80
|
| Rate for Payer: GEHA Medicare |
$6,205.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,998.90
|
| Rate for Payer: Humana ChoiceCare |
$6,825.96
|
| Rate for Payer: Humana Medicare Advantage |
$6,205.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,425.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,205.42
|
| Rate for Payer: Multiplan All |
$2,021.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,549.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,554.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,998.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,205.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,109.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,410.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,665.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,081.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,205.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,065.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,205.42
|
| Rate for Payer: Zelis Auto |
$888.40
|
| Rate for Payer: Zelis Medicare |
$5,274.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,446.50
|
| Rate for Payer: Zelis Worker's Compensation |
$606.33
|
|
