|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 27695
|
| Hospital Charge Code |
6127695
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.54 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$581.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: First Health Workers Compensation |
$374.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$387.60
|
| 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 |
$264.54
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
OP
|
$1,878.51
|
|
|
Service Code
|
CPT 27698
|
| Hospital Charge Code |
6127698
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.83 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$1,127.11
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,127.11
|
| Rate for Payer: Cash Price |
$1,127.11
|
| Rate for Payer: Cigna Commercial |
$1,596.73
|
| Rate for Payer: First Health Commercial |
$1,690.66
|
| Rate for Payer: First Health Workers Compensation |
$725.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.66
|
| Rate for Payer: GEHA Commercial |
$1,502.81
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.66
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,709.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.96
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.66
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.88
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$751.40
|
| 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 |
$512.83
|
|
|
REPAIR OF ANKLE LIGAMENTS
|
Facility
|
IP
|
$1,139.00
|
|
|
Service Code
|
CPT 27696
|
| Hospital Charge Code |
6127696
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.95 |
| Max. Negotiated Rate |
$1,082.05 |
| Rate for Payer: Cash Price |
$683.40
|
| Rate for Payer: Cigna Commercial |
$968.15
|
| Rate for Payer: First Health Commercial |
$1,025.10
|
| Rate for Payer: First Health Workers Compensation |
$439.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,025.10
|
| Rate for Payer: GEHA Commercial |
$797.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,025.10
|
| Rate for Payer: Multiplan All |
$1,036.49
|
| Rate for Payer: OMNI Networks Commercial |
$797.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,025.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,082.05
|
| Rate for Payer: Three Rivers Provider Network All |
$854.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,059.27
|
| Rate for Payer: Zelis Auto |
$455.60
|
| Rate for Payer: Zelis Worker's Compensation |
$310.95
|
|
|
REPAIR OF ANKLE LIGAMENTS
|
Facility
|
OP
|
$1,139.00
|
|
|
Service Code
|
CPT 27696
|
| Hospital Charge Code |
6127696
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.95 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$683.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$683.40
|
| Rate for Payer: Cash Price |
$683.40
|
| Rate for Payer: Cigna Commercial |
$968.15
|
| Rate for Payer: First Health Commercial |
$1,025.10
|
| Rate for Payer: First Health Workers Compensation |
$439.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,025.10
|
| Rate for Payer: GEHA Commercial |
$911.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,025.10
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,036.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$797.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,025.10
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,082.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$854.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,059.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$455.60
|
| 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 |
$310.95
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 49594
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,708.97 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,818.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,818.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,193.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,319.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7,297.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,319.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,319.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$5,041.36
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE
|
Facility
|
OP
|
$11,849.78
|
|
|
Service Code
|
CPT 49593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.88 |
| Max. Negotiated Rate |
$11,849.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,312.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,312.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,208.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,924.89
|
| Rate for Payer: First Health Workers Compensation |
$7,625.33
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Humana ChoiceCare |
$6,517.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,924.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,953.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,294.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,924.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,958.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,294.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,294.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,924.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Medicare |
$5,036.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,109.87
|
| Rate for Payer: Zelis Worker's Compensation |
$5,391.65
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM, REDUCIBLE
|
Facility
|
OP
|
$11,849.78
|
|
|
Service Code
|
CPT 49595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.88 |
| Max. Negotiated Rate |
$11,849.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,312.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,312.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,208.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,924.89
|
| Rate for Payer: First Health Workers Compensation |
$7,625.33
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Humana ChoiceCare |
$6,517.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,924.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,953.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,294.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,924.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,958.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,294.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,294.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,924.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Medicare |
$5,036.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,109.87
|
| Rate for Payer: Zelis Worker's Compensation |
$5,391.65
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$11,079.92
|
|
|
Service Code
|
CPT 49592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,708.97 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,818.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,818.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,193.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: First Health Workers Compensation |
$7,129.93
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,319.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7,297.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,319.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,319.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$5,041.36
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$6,701.96
|
|
|
Service Code
|
CPT 49591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,848.33 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,312.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,312.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,208.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: First Health Workers Compensation |
$4,312.71
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,294.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,958.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,294.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,294.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3,049.39
|
|
|
REPAIR OF ARM NERVES
|
Facility
|
OP
|
$2,756.00
|
|
|
Service Code
|
CPT 64861
|
| Hospital Charge Code |
6164861
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$752.39 |
| Max. Negotiated Rate |
$3,769.41 |
| 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 |
$1,653.60
|
| 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 |
$1,854.23
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$2,342.60
|
| Rate for Payer: First Health Commercial |
$2,480.40
|
| Rate for Payer: First Health Workers Compensation |
$1,064.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,480.40
|
| Rate for Payer: GEHA Commercial |
$2,204.80
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,480.40
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$2,507.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,929.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,480.40
|
| 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 |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,618.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$2,067.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,563.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$1,102.40
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$752.39
|
|
|
REPAIR OF ARM NERVES
|
Facility
|
IP
|
$2,756.00
|
|
|
Service Code
|
CPT 64861
|
| Hospital Charge Code |
6164861
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$752.39 |
| Max. Negotiated Rate |
$2,618.20 |
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$2,342.60
|
| Rate for Payer: First Health Commercial |
$2,480.40
|
| Rate for Payer: First Health Workers Compensation |
$1,064.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,480.40
|
| Rate for Payer: GEHA Commercial |
$1,929.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,480.40
|
| Rate for Payer: Multiplan All |
$2,507.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,929.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,480.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,618.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,067.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,563.08
|
| Rate for Payer: Zelis Auto |
$1,102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$752.39
|
|
|
REPAIR OF ARM TENDON
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
CPT 24320
|
| Hospital Charge Code |
6124320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$437.89 |
| Max. Negotiated Rate |
$1,523.80 |
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cigna Commercial |
$1,363.40
|
| Rate for Payer: First Health Commercial |
$1,443.60
|
| Rate for Payer: First Health Workers Compensation |
$619.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,443.60
|
| Rate for Payer: GEHA Commercial |
$1,122.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,443.60
|
| Rate for Payer: Multiplan All |
$1,459.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,122.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,443.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,523.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,491.72
|
| Rate for Payer: Zelis Auto |
$641.60
|
| Rate for Payer: Zelis Worker's Compensation |
$437.89
|
|
|
REPAIR OF ARM TENDON
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
CPT 24320
|
| Hospital Charge Code |
6124320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$437.89 |
| 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 |
$962.40
|
| 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 |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cigna Commercial |
$1,363.40
|
| Rate for Payer: First Health Commercial |
$1,443.60
|
| Rate for Payer: First Health Workers Compensation |
$619.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,443.60
|
| Rate for Payer: GEHA Commercial |
$1,283.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,443.60
|
| 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 |
$1,459.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,122.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,443.60
|
| 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 |
$1,523.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.00
|
| 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 |
$1,491.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$641.60
|
| 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 |
$437.89
|
|
|
REPAIR OF BICEPS TENDON
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 24340
|
| Hospital Charge Code |
6124340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.98 |
| Max. Negotiated Rate |
$1,186.55 |
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$1,061.65
|
| Rate for Payer: First Health Commercial |
$1,124.10
|
| Rate for Payer: First Health Workers Compensation |
$482.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,124.10
|
| Rate for Payer: GEHA Commercial |
$874.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,124.10
|
| Rate for Payer: Multiplan All |
$1,136.59
|
| Rate for Payer: OMNI Networks Commercial |
$874.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,124.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,186.55
|
| Rate for Payer: Three Rivers Provider Network All |
$936.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,161.57
|
| Rate for Payer: Zelis Auto |
$499.60
|
| Rate for Payer: Zelis Worker's Compensation |
$340.98
|
|
|
REPAIR OF BICEPS TENDON
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 24340
|
| Hospital Charge Code |
6124340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.98 |
| 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 |
$749.40
|
| 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 |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$1,061.65
|
| Rate for Payer: First Health Commercial |
$1,124.10
|
| Rate for Payer: First Health Workers Compensation |
$482.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,124.10
|
| Rate for Payer: GEHA Commercial |
$999.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,124.10
|
| 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 |
$1,136.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$874.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,124.10
|
| 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 |
$1,186.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$936.75
|
| 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 |
$1,161.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$499.60
|
| 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 |
$340.98
|
|
|
REPAIR OF BLADDER OPENING
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 51880
|
| Hospital Charge Code |
6151880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$578.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
REPAIR OF BLADDER OPENING
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 51880
|
| Hospital Charge Code |
6151880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
OP
|
$2,103.69
|
|
|
Service Code
|
CPT 51860
|
| Hospital Charge Code |
6151860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.31 |
| Max. Negotiated Rate |
$17,561.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,262.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,780.54
|
| Rate for Payer: Cash Price |
$1,262.21
|
| Rate for Payer: Cash Price |
$1,262.21
|
| Rate for Payer: Cigna Commercial |
$1,788.14
|
| Rate for Payer: First Health Commercial |
$1,893.32
|
| Rate for Payer: First Health Workers Compensation |
$812.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,893.32
|
| Rate for Payer: GEHA Commercial |
$1,682.95
|
| Rate for Payer: GEHA Medicare |
$8,780.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$9,658.59
|
| Rate for Payer: Humana Medicare Advantage |
$8,780.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,751.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,780.54
|
| Rate for Payer: Multiplan All |
$1,914.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,926.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,472.58
|
| Rate for Payer: One Health Plan PPO/POS |
$1,893.32
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,780.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,998.51
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,561.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,577.77
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,604.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,780.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,956.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,780.54
|
| Rate for Payer: Zelis Auto |
$841.48
|
| Rate for Payer: Zelis Medicare |
$7,463.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,536.65
|
| Rate for Payer: Zelis Worker's Compensation |
$574.31
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
IP
|
$1,849.00
|
|
|
Service Code
|
CPT 51865
|
| Hospital Charge Code |
6151865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$504.78 |
| Max. Negotiated Rate |
$1,756.55 |
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cigna Commercial |
$1,571.65
|
| Rate for Payer: First Health Commercial |
$1,664.10
|
| Rate for Payer: First Health Workers Compensation |
$713.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,664.10
|
| Rate for Payer: GEHA Commercial |
$1,294.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,664.10
|
| Rate for Payer: Multiplan All |
$1,682.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,294.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,664.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,756.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,719.57
|
| Rate for Payer: Zelis Auto |
$739.60
|
| Rate for Payer: Zelis Worker's Compensation |
$504.78
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
IP
|
$2,103.69
|
|
|
Service Code
|
CPT 51860
|
| Hospital Charge Code |
6151860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.31 |
| Max. Negotiated Rate |
$1,998.51 |
| Rate for Payer: Cash Price |
$1,262.21
|
| Rate for Payer: Cigna Commercial |
$1,788.14
|
| Rate for Payer: First Health Commercial |
$1,893.32
|
| Rate for Payer: First Health Workers Compensation |
$812.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,893.32
|
| Rate for Payer: GEHA Commercial |
$1,472.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,893.32
|
| Rate for Payer: Multiplan All |
$1,914.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,472.58
|
| Rate for Payer: One Health Plan PPO/POS |
$1,893.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,998.51
|
| Rate for Payer: Three Rivers Provider Network All |
$1,577.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,956.43
|
| Rate for Payer: Zelis Auto |
$841.48
|
| Rate for Payer: Zelis Worker's Compensation |
$574.31
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
OP
|
$1,849.00
|
|
|
Service Code
|
CPT 51865
|
| Hospital Charge Code |
6151865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.25 |
| Max. Negotiated Rate |
$1,756.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,109.40
|
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cigna Commercial |
$1,571.65
|
| Rate for Payer: First Health Commercial |
$1,664.10
|
| Rate for Payer: First Health Workers Compensation |
$713.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,664.10
|
| Rate for Payer: GEHA Commercial |
$1,479.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,664.10
|
| Rate for Payer: Humana ChoiceCare |
$480.74
|
| Rate for Payer: Multiplan All |
$1,682.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,109.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,294.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,664.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,756.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,627.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$462.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,719.57
|
| Rate for Payer: Zelis Auto |
$739.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$924.50
|
| Rate for Payer: Zelis Worker's Compensation |
$504.78
|
|
|
REPAIR OF BODY CAST
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
8229720
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
REPAIR OF BODY CAST
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
8229720
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
REPAIR OF BOWEL BULGE
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 57268
|
| Hospital Charge Code |
6157268
|
|
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 OF BOWEL BULGE
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 57268
|
| Hospital Charge Code |
6157268
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.27 |
| 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 |
$587.40
|
| 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 |
$4,687.36
|
| 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 |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| 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 |
$890.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| 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 |
$3,328.05
|
| 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 |
$930.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| 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 |
$910.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$391.60
|
| 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 |
$267.27
|
|
