|
REPAIR ACHILLES TENDON
|
Facility
|
IP
|
$1,930.38
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
6127650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$526.99 |
| Max. Negotiated Rate |
$1,833.86 |
| Rate for Payer: Cash Price |
$1,158.23
|
| Rate for Payer: Cigna Commercial |
$1,640.82
|
| Rate for Payer: First Health Commercial |
$1,737.34
|
| Rate for Payer: First Health Workers Compensation |
$745.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.34
|
| Rate for Payer: GEHA Commercial |
$1,351.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.34
|
| Rate for Payer: Multiplan All |
$1,756.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.27
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,833.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,447.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,795.25
|
| Rate for Payer: Zelis Auto |
$772.15
|
| Rate for Payer: Zelis Worker's Compensation |
$526.99
|
|
|
REPAIR ANAL FISTULA
|
Facility
|
IP
|
$1,131.00
|
|
|
Service Code
|
CPT 46288
|
| Hospital Charge Code |
6146288
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$308.76 |
| Max. Negotiated Rate |
$1,074.45 |
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$961.35
|
| Rate for Payer: First Health Commercial |
$1,017.90
|
| Rate for Payer: First Health Workers Compensation |
$436.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,017.90
|
| Rate for Payer: GEHA Commercial |
$791.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,017.90
|
| Rate for Payer: Multiplan All |
$1,029.21
|
| Rate for Payer: OMNI Networks Commercial |
$791.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,017.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,074.45
|
| Rate for Payer: Three Rivers Provider Network All |
$848.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,051.83
|
| Rate for Payer: Zelis Auto |
$452.40
|
| Rate for Payer: Zelis Worker's Compensation |
$308.76
|
|
|
REPAIR ANAL FISTULA
|
Facility
|
OP
|
$1,131.00
|
|
|
Service Code
|
CPT 46288
|
| Hospital Charge Code |
6146288
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$308.76 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$678.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$961.35
|
| Rate for Payer: First Health Commercial |
$1,017.90
|
| Rate for Payer: First Health Workers Compensation |
$436.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,017.90
|
| Rate for Payer: GEHA Commercial |
$904.80
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,017.90
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,029.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$791.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,017.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,074.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$848.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,051.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$452.40
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$308.76
|
|
|
REPAIR ANORECTAL FIST W/PLUG
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 46707
|
| Hospital Charge Code |
6146707
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$930.05 |
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$685.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
REPAIR ANORECTAL FIST W/PLUG
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 46707
|
| Hospital Charge Code |
6146707
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$587.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$783.20
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
REPAIR ARM/LEG NERVE
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
CPT 64857
|
| Hospital Charge Code |
6164857
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$593.77 |
| Max. Negotiated Rate |
$12,161.84 |
| 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 |
$1,305.00
|
| 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 |
$6,080.92
|
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Cigna Commercial |
$1,848.75
|
| Rate for Payer: First Health Commercial |
$1,957.50
|
| Rate for Payer: First Health Workers Compensation |
$839.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,957.50
|
| Rate for Payer: GEHA Commercial |
$1,740.00
|
| Rate for Payer: GEHA Medicare |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,957.50
|
| Rate for Payer: Humana ChoiceCare |
$6,689.01
|
| Rate for Payer: Humana Medicare Advantage |
$6,080.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,215.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,080.92
|
| Rate for Payer: Multiplan All |
$1,979.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,522.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,957.50
|
| 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 |
$6,080.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,066.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,631.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,959.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,080.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,022.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$870.00
|
| Rate for Payer: Zelis Medicare |
$5,168.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,297.10
|
| Rate for Payer: Zelis Worker's Compensation |
$593.77
|
|
|
REPAIR ARM/LEG NERVE
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
CPT 64857
|
| Hospital Charge Code |
6164857
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$593.77 |
| Max. Negotiated Rate |
$2,066.25 |
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Cigna Commercial |
$1,848.75
|
| Rate for Payer: First Health Commercial |
$1,957.50
|
| Rate for Payer: First Health Workers Compensation |
$839.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,957.50
|
| Rate for Payer: GEHA Commercial |
$1,522.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,957.50
|
| Rate for Payer: Multiplan All |
$1,979.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,522.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,957.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,066.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,631.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,022.75
|
| Rate for Payer: Zelis Auto |
$870.00
|
| Rate for Payer: Zelis Worker's Compensation |
$593.77
|
|
|
REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
6124341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,215.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,382.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,443.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,412.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$607.60
|
| 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 |
$414.69
|
|
|
REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
6124341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,063.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| Rate for Payer: Multiplan All |
$1,382.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,443.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,412.67
|
| Rate for Payer: Zelis Auto |
$607.60
|
| Rate for Payer: Zelis Worker's Compensation |
$414.69
|
|
|
REPAIR BICEPS TENDON
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 23430
|
| Hospital Charge Code |
6123430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.87 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$916.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cigna Commercial |
$1,297.95
|
| Rate for Payer: First Health Commercial |
$1,374.30
|
| Rate for Payer: First Health Workers Compensation |
$589.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,374.30
|
| Rate for Payer: GEHA Commercial |
$1,221.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,374.30
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,389.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,374.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,450.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,145.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,420.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$610.80
|
| 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 |
$416.87
|
|
|
REPAIR BICEPS TENDON
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 23430
|
| Hospital Charge Code |
6123430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.87 |
| Max. Negotiated Rate |
$1,450.65 |
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cigna Commercial |
$1,297.95
|
| Rate for Payer: First Health Commercial |
$1,374.30
|
| Rate for Payer: First Health Workers Compensation |
$589.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,374.30
|
| Rate for Payer: GEHA Commercial |
$1,068.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,374.30
|
| Rate for Payer: Multiplan All |
$1,389.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,374.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,450.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,145.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,420.11
|
| Rate for Payer: Zelis Auto |
$610.80
|
| Rate for Payer: Zelis Worker's Compensation |
$416.87
|
|
|
REPAIR BLADDER DEFECT
|
Facility
|
OP
|
$2,193.15
|
|
|
Service Code
|
CPT 57288
|
| Hospital Charge Code |
6157288
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$598.73 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,315.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$1,315.89
|
| Rate for Payer: Cash Price |
$1,315.89
|
| Rate for Payer: Cigna Commercial |
$1,864.18
|
| Rate for Payer: First Health Commercial |
$1,973.84
|
| Rate for Payer: First Health Workers Compensation |
$846.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,973.84
|
| Rate for Payer: GEHA Commercial |
$1,754.52
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,973.84
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,995.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,973.84
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,083.49
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,644.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,039.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$877.26
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$598.73
|
|
|
REPAIR BLADDER DEFECT
|
Facility
|
IP
|
$2,193.15
|
|
|
Service Code
|
CPT 57288
|
| Hospital Charge Code |
6157288
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$598.73 |
| Max. Negotiated Rate |
$2,083.49 |
| Rate for Payer: Cash Price |
$1,315.89
|
| Rate for Payer: Cigna Commercial |
$1,864.18
|
| Rate for Payer: First Health Commercial |
$1,973.84
|
| Rate for Payer: First Health Workers Compensation |
$846.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,973.84
|
| Rate for Payer: GEHA Commercial |
$1,535.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,973.84
|
| Rate for Payer: Multiplan All |
$1,995.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,973.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,083.49
|
| Rate for Payer: Three Rivers Provider Network All |
$1,644.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,039.63
|
| Rate for Payer: Zelis Auto |
$877.26
|
| Rate for Payer: Zelis Worker's Compensation |
$598.73
|
|
|
REPAIR BLADDER NECK
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
CPT 51845
|
| Hospital Charge Code |
6151845
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.24 |
| Max. Negotiated Rate |
$1,145.70 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$1,025.10
|
| Rate for Payer: First Health Commercial |
$1,085.40
|
| Rate for Payer: First Health Workers Compensation |
$465.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,085.40
|
| Rate for Payer: GEHA Commercial |
$844.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,085.40
|
| Rate for Payer: Multiplan All |
$1,097.46
|
| Rate for Payer: OMNI Networks Commercial |
$844.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,085.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,145.70
|
| Rate for Payer: Three Rivers Provider Network All |
$904.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,121.58
|
| Rate for Payer: Zelis Auto |
$482.40
|
| Rate for Payer: Zelis Worker's Compensation |
$329.24
|
|
|
REPAIR BLADDER NECK
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
CPT 51845
|
| Hospital Charge Code |
6151845
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.24 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$723.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$1,025.10
|
| Rate for Payer: First Health Commercial |
$1,085.40
|
| Rate for Payer: First Health Workers Compensation |
$465.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,085.40
|
| Rate for Payer: GEHA Commercial |
$964.80
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,085.40
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,097.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$844.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,085.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,145.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$904.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,121.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$482.40
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$329.24
|
|
|
REPAIR BLADDER & VAGINA
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 57289
|
| Hospital Charge Code |
6157289
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$14,043.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| 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 |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,021.67
|
| 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 |
$7,021.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| Rate for Payer: Humana ChoiceCare |
$7,723.84
|
| Rate for Payer: Humana Medicare Advantage |
$7,021.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,796.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,021.67
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,936.84
|
| 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 |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,021.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,043.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,881.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,021.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,021.67
|
| Rate for Payer: Zelis Auto |
$599.20
|
| Rate for Payer: Zelis Medicare |
$5,968.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$408.95
|
|
|
REPAIR BLADDER & VAGINA
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 57289
|
| Hospital Charge Code |
6157289
|
|
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
|
|
|
REPAIR BLADDER-VAGINA LESION
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 57330
|
| Hospital Charge Code |
6157330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,063.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| Rate for Payer: Multiplan All |
$1,382.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,443.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,412.67
|
| Rate for Payer: Zelis Auto |
$607.60
|
| Rate for Payer: Zelis Worker's Compensation |
$414.69
|
|
|
REPAIR BLADDER-VAGINA LESION
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 57330
|
| Hospital Charge Code |
6157330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| Max. Negotiated Rate |
$14,043.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,021.67
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,215.20
|
| Rate for Payer: GEHA Medicare |
$7,021.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| Rate for Payer: Humana ChoiceCare |
$7,723.84
|
| Rate for Payer: Humana Medicare Advantage |
$7,021.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,796.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,021.67
|
| Rate for Payer: Multiplan All |
$1,382.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,936.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,021.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,443.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,043.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,881.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,021.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,412.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,021.67
|
| Rate for Payer: Zelis Auto |
$607.60
|
| Rate for Payer: Zelis Medicare |
$5,968.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$414.69
|
|
|
REPAIR BLADDER-VAGINA LESION
|
Facility
|
IP
|
$1,091.00
|
|
|
Service Code
|
CPT 57320
|
| Hospital Charge Code |
6157320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.84 |
| Max. Negotiated Rate |
$1,036.45 |
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$927.35
|
| Rate for Payer: First Health Commercial |
$981.90
|
| Rate for Payer: First Health Workers Compensation |
$421.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$981.90
|
| Rate for Payer: GEHA Commercial |
$763.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$981.90
|
| Rate for Payer: Multiplan All |
$992.81
|
| Rate for Payer: OMNI Networks Commercial |
$763.70
|
| Rate for Payer: One Health Plan PPO/POS |
$981.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,036.45
|
| Rate for Payer: Three Rivers Provider Network All |
$818.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,014.63
|
| Rate for Payer: Zelis Auto |
$436.40
|
| Rate for Payer: Zelis Worker's Compensation |
$297.84
|
|
|
REPAIR BLADDER-VAGINA LESION
|
Facility
|
OP
|
$1,091.00
|
|
|
Service Code
|
CPT 57320
|
| Hospital Charge Code |
6157320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.84 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$654.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$927.35
|
| Rate for Payer: First Health Commercial |
$981.90
|
| Rate for Payer: First Health Workers Compensation |
$421.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$981.90
|
| Rate for Payer: GEHA Commercial |
$872.80
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$981.90
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$992.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$763.70
|
| Rate for Payer: One Health Plan PPO/POS |
$981.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,036.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$818.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,014.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$436.40
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$297.84
|
|
|
REPAIR BLADDER/VAGINA LESION
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 51900
|
| Hospital Charge Code |
6151900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$470.11 |
| Max. Negotiated Rate |
$1,635.90 |
| Rate for Payer: Cash Price |
$1,033.20
|
| Rate for Payer: Cigna Commercial |
$1,463.70
|
| Rate for Payer: First Health Commercial |
$1,549.80
|
| Rate for Payer: First Health Workers Compensation |
$664.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,549.80
|
| Rate for Payer: GEHA Commercial |
$1,205.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,549.80
|
| Rate for Payer: Multiplan All |
$1,567.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,205.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,549.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,635.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,291.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,601.46
|
| Rate for Payer: Zelis Auto |
$688.80
|
| Rate for Payer: Zelis Worker's Compensation |
$470.11
|
|
|
REPAIR BLADDER/VAGINA LESION
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 51900
|
| Hospital Charge Code |
6151900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$1,635.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,033.20
|
| Rate for Payer: Cash Price |
$1,033.20
|
| Rate for Payer: Cigna Commercial |
$1,463.70
|
| Rate for Payer: First Health Commercial |
$1,549.80
|
| Rate for Payer: First Health Workers Compensation |
$664.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,549.80
|
| Rate for Payer: GEHA Commercial |
$1,377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,549.80
|
| Rate for Payer: Humana ChoiceCare |
$447.72
|
| Rate for Payer: Multiplan All |
$1,567.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,033.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,205.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,549.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,635.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,291.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,515.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$430.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,601.46
|
| Rate for Payer: Zelis Auto |
$688.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$861.00
|
| Rate for Payer: Zelis Worker's Compensation |
$470.11
|
|
|
REPAIR BLOOD VESSEL DIRECT HAND/FINGER
|
Facility
|
IP
|
$9,566.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
8135207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,611.52 |
| Max. Negotiated Rate |
$9,087.70 |
| Rate for Payer: Cash Price |
$5,739.60
|
| Rate for Payer: Cigna Commercial |
$8,131.10
|
| Rate for Payer: First Health Commercial |
$8,609.40
|
| Rate for Payer: First Health Workers Compensation |
$3,693.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,609.40
|
| Rate for Payer: GEHA Commercial |
$6,696.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,609.40
|
| Rate for Payer: Multiplan All |
$8,705.06
|
| Rate for Payer: OMNI Networks Commercial |
$6,696.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,609.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,087.70
|
| Rate for Payer: Three Rivers Provider Network All |
$7,174.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,896.38
|
| Rate for Payer: Zelis Auto |
$3,826.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,611.52
|
|
|
REPAIR BLOOD VESSEL DIRECT HAND/FINGER
|
Facility
|
OP
|
$9,566.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
8135207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,540.38 |
| Max. Negotiated Rate |
$9,087.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,739.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,135.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$5,739.60
|
| Rate for Payer: Cash Price |
$5,739.60
|
| Rate for Payer: Cigna Commercial |
$8,131.10
|
| Rate for Payer: First Health Commercial |
$8,609.40
|
| Rate for Payer: First Health Workers Compensation |
$3,693.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,609.40
|
| Rate for Payer: GEHA Commercial |
$7,652.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,609.40
|
| 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 |
$3,342.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$8,705.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$6,696.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,609.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,859.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,342.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,087.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$7,174.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,342.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,896.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$3,826.40
|
| 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 |
$2,611.52
|
|
