|
REPAIR OF LOWER LEG
|
Facility
|
IP
|
$2,485.00
|
|
|
Service Code
|
CPT 27725
|
| Hospital Charge Code |
6127725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$678.40 |
| Max. Negotiated Rate |
$2,360.75 |
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$2,112.25
|
| Rate for Payer: First Health Commercial |
$2,236.50
|
| Rate for Payer: First Health Workers Compensation |
$959.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,236.50
|
| Rate for Payer: GEHA Commercial |
$1,739.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,236.50
|
| Rate for Payer: Multiplan All |
$2,261.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,739.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,236.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,360.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,863.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,311.05
|
| Rate for Payer: Zelis Auto |
$994.00
|
| Rate for Payer: Zelis Worker's Compensation |
$678.40
|
|
|
REPAIR OF MESENTERY
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
CPT 44850
|
| Hospital Charge Code |
6144850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$430.25 |
| Max. Negotiated Rate |
$1,497.20 |
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$1,339.60
|
| Rate for Payer: First Health Commercial |
$1,418.40
|
| Rate for Payer: First Health Workers Compensation |
$608.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,418.40
|
| Rate for Payer: GEHA Commercial |
$1,103.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,418.40
|
| Rate for Payer: Multiplan All |
$1,434.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,418.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,497.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,465.68
|
| Rate for Payer: Zelis Auto |
$630.40
|
| Rate for Payer: Zelis Worker's Compensation |
$430.25
|
|
|
REPAIR OF MESENTERY
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 44850
|
| Hospital Charge Code |
6144850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$394.00 |
| Max. Negotiated Rate |
$1,497.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$1,339.60
|
| Rate for Payer: First Health Commercial |
$1,418.40
|
| Rate for Payer: First Health Workers Compensation |
$608.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,418.40
|
| Rate for Payer: GEHA Commercial |
$1,260.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,418.40
|
| Rate for Payer: Humana ChoiceCare |
$409.76
|
| Rate for Payer: Multiplan All |
$1,434.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$945.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,418.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,497.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,386.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,465.68
|
| Rate for Payer: Zelis Auto |
$630.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$788.00
|
| Rate for Payer: Zelis Worker's Compensation |
$430.25
|
|
|
REPAIR OF METATARSALS
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
6128322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.05 |
| Max. Negotiated Rate |
$1,127.65 |
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$1,008.95
|
| Rate for Payer: First Health Commercial |
$1,068.30
|
| Rate for Payer: First Health Workers Compensation |
$458.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,068.30
|
| Rate for Payer: GEHA Commercial |
$830.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,068.30
|
| Rate for Payer: Multiplan All |
$1,080.17
|
| Rate for Payer: OMNI Networks Commercial |
$830.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,068.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,127.65
|
| Rate for Payer: Three Rivers Provider Network All |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,103.91
|
| Rate for Payer: Zelis Auto |
$474.80
|
| Rate for Payer: Zelis Worker's Compensation |
$324.05
|
|
|
REPAIR OF METATARSALS
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
6128322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.05 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$712.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$1,008.95
|
| Rate for Payer: First Health Commercial |
$1,068.30
|
| Rate for Payer: First Health Workers Compensation |
$458.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,068.30
|
| Rate for Payer: GEHA Commercial |
$949.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,068.30
|
| 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 |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,080.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$830.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,068.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,127.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$890.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,103.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$474.80
|
| 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 |
$324.05
|
|
|
REPAIR OF NAIL BED
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
6111760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
REPAIR OF NAIL BED
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
6111760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
REPAIR OF NASAL SEPTUM
|
Facility
|
IP
|
$1,252.00
|
|
|
Service Code
|
CPT 30520
|
| Hospital Charge Code |
6130520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$341.80 |
| Max. Negotiated Rate |
$1,189.40 |
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$1,064.20
|
| Rate for Payer: First Health Commercial |
$1,126.80
|
| Rate for Payer: First Health Workers Compensation |
$483.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,126.80
|
| Rate for Payer: GEHA Commercial |
$876.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,126.80
|
| Rate for Payer: Multiplan All |
$1,139.32
|
| Rate for Payer: OMNI Networks Commercial |
$876.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,126.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,189.40
|
| Rate for Payer: Three Rivers Provider Network All |
$939.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,164.36
|
| Rate for Payer: Zelis Auto |
$500.80
|
| Rate for Payer: Zelis Worker's Compensation |
$341.80
|
|
|
REPAIR OF NASAL SEPTUM
|
Facility
|
OP
|
$1,252.00
|
|
|
Service Code
|
CPT 30520
|
| Hospital Charge Code |
6130520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$341.80 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$751.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$1,064.20
|
| Rate for Payer: First Health Commercial |
$1,126.80
|
| Rate for Payer: First Health Workers Compensation |
$483.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,126.80
|
| Rate for Payer: GEHA Commercial |
$1,001.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,126.80
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,139.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$876.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,126.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,189.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$939.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,164.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$500.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$341.80
|
|
|
REPAIR OF PENIS
|
Facility
|
IP
|
$1,757.00
|
|
|
Service Code
|
CPT 54440
|
| Hospital Charge Code |
8554440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$479.66 |
| Max. Negotiated Rate |
$1,669.15 |
| Rate for Payer: Cash Price |
$1,054.20
|
| Rate for Payer: Cigna Commercial |
$1,493.45
|
| Rate for Payer: First Health Commercial |
$1,581.30
|
| Rate for Payer: First Health Workers Compensation |
$678.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,581.30
|
| Rate for Payer: GEHA Commercial |
$1,229.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,581.30
|
| Rate for Payer: Multiplan All |
$1,598.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,581.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,669.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,634.01
|
| Rate for Payer: Zelis Auto |
$702.80
|
| Rate for Payer: Zelis Worker's Compensation |
$479.66
|
|
|
REPAIR OF PENIS
|
Facility
|
OP
|
$1,757.00
|
|
|
Service Code
|
CPT 54440
|
| Hospital Charge Code |
8554440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$479.66 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,054.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,054.20
|
| Rate for Payer: Cash Price |
$1,054.20
|
| Rate for Payer: Cigna Commercial |
$1,493.45
|
| Rate for Payer: First Health Commercial |
$1,581.30
|
| Rate for Payer: First Health Workers Compensation |
$678.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,581.30
|
| Rate for Payer: GEHA Commercial |
$1,405.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,581.30
|
| 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 |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,598.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,581.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,669.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,634.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$702.80
|
| 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 |
$479.66
|
|
|
REPAIR OF PERINEUM
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
6156810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$462.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
REPAIR OF PERINEUM
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
6156810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$528.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
REPAIR OF RECTOCELE
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT 45560
|
| Hospital Charge Code |
6145560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$387.11 |
| 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 |
$850.80
|
| 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 |
$850.80
|
| Rate for Payer: Cash Price |
$850.80
|
| Rate for Payer: Cigna Commercial |
$1,205.30
|
| Rate for Payer: First Health Commercial |
$1,276.20
|
| Rate for Payer: First Health Workers Compensation |
$547.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,276.20
|
| Rate for Payer: GEHA Commercial |
$1,134.40
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,276.20
|
| 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 |
$1,290.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$992.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,276.20
|
| 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 |
$1,347.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$1,063.50
|
| 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 |
$1,318.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$567.20
|
| 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 |
$387.11
|
|
|
REPAIR OF RECTOCELE
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
CPT 45560
|
| Hospital Charge Code |
6145560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$387.11 |
| Max. Negotiated Rate |
$1,347.10 |
| Rate for Payer: Cash Price |
$850.80
|
| Rate for Payer: Cigna Commercial |
$1,205.30
|
| Rate for Payer: First Health Commercial |
$1,276.20
|
| Rate for Payer: First Health Workers Compensation |
$547.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,276.20
|
| Rate for Payer: GEHA Commercial |
$992.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,276.20
|
| Rate for Payer: Multiplan All |
$1,290.38
|
| Rate for Payer: OMNI Networks Commercial |
$992.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,276.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,347.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,063.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,318.74
|
| Rate for Payer: Zelis Auto |
$567.20
|
| Rate for Payer: Zelis Worker's Compensation |
$387.11
|
|
|
REPAIR OF RECTUM
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 45505
|
| Hospital Charge Code |
6145505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.61 |
| Max. Negotiated Rate |
$1,160.90 |
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cigna Commercial |
$1,038.70
|
| Rate for Payer: First Health Commercial |
$1,099.80
|
| Rate for Payer: First Health Workers Compensation |
$471.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,099.80
|
| Rate for Payer: GEHA Commercial |
$855.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,099.80
|
| Rate for Payer: Multiplan All |
$1,112.02
|
| Rate for Payer: OMNI Networks Commercial |
$855.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,099.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,160.90
|
| Rate for Payer: Three Rivers Provider Network All |
$916.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,136.46
|
| Rate for Payer: Zelis Auto |
$488.80
|
| Rate for Payer: Zelis Worker's Compensation |
$333.61
|
|
|
REPAIR OF RECTUM
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 45500
|
| Hospital Charge Code |
6145500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.11 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: First Health Workers Compensation |
$413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$749.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| Rate for Payer: Multiplan All |
$973.70
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,016.50
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$995.10
|
| Rate for Payer: Zelis Auto |
$428.00
|
| Rate for Payer: Zelis Worker's Compensation |
$292.11
|
|
|
REPAIR OF RECTUM
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 45505
|
| Hospital Charge Code |
6145505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.61 |
| 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 |
$733.20
|
| 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 |
$733.20
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cigna Commercial |
$1,038.70
|
| Rate for Payer: First Health Commercial |
$1,099.80
|
| Rate for Payer: First Health Workers Compensation |
$471.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,099.80
|
| Rate for Payer: GEHA Commercial |
$977.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,099.80
|
| 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 |
$1,112.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$855.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,099.80
|
| 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 |
$1,160.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$916.50
|
| 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 |
$1,136.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$488.80
|
| 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 |
$333.61
|
|
|
REPAIR OF RECTUM
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 45500
|
| Hospital Charge Code |
6145500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.11 |
| 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 |
$642.00
|
| 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 |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: First Health Workers Compensation |
$413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$856.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| 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 |
$973.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| 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 |
$1,016.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| 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 |
$995.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$428.00
|
| 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 |
$292.11
|
|
|
REPAIR OF RUPTURED TENDON
|
Facility
|
IP
|
$1,589.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
6124342
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$1,509.55 |
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$1,350.65
|
| Rate for Payer: First Health Commercial |
$1,430.10
|
| Rate for Payer: First Health Workers Compensation |
$613.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,430.10
|
| Rate for Payer: GEHA Commercial |
$1,112.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,430.10
|
| Rate for Payer: Multiplan All |
$1,445.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,112.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,430.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,509.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,477.77
|
| Rate for Payer: Zelis Auto |
$635.60
|
| Rate for Payer: Zelis Worker's Compensation |
$433.80
|
|
|
REPAIR OF RUPTURED TENDON
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
6124342
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.80 |
| 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 |
$953.40
|
| 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 |
$953.40
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$1,350.65
|
| Rate for Payer: First Health Commercial |
$1,430.10
|
| Rate for Payer: First Health Workers Compensation |
$613.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,430.10
|
| Rate for Payer: GEHA Commercial |
$1,271.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,430.10
|
| 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 |
$1,445.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,112.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,430.10
|
| 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 |
$1,509.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.75
|
| 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 |
$1,477.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$635.60
|
| 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 |
$433.80
|
|
|
REPAIR OF SHOULDER
|
Facility
|
IP
|
$1,989.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
6123420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$1,889.55 |
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$1,690.65
|
| Rate for Payer: First Health Commercial |
$1,790.10
|
| Rate for Payer: First Health Workers Compensation |
$767.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.10
|
| Rate for Payer: GEHA Commercial |
$1,392.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.10
|
| Rate for Payer: Multiplan All |
$1,809.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,889.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,849.77
|
| Rate for Payer: Zelis Auto |
$795.60
|
| Rate for Payer: Zelis Worker's Compensation |
$543.00
|
|
|
REPAIR OF SHOULDER
|
Facility
|
OP
|
$1,989.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
6123420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.00 |
| 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 |
$1,193.40
|
| 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 |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$1,690.65
|
| Rate for Payer: First Health Commercial |
$1,790.10
|
| Rate for Payer: First Health Workers Compensation |
$767.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.10
|
| Rate for Payer: GEHA Commercial |
$1,591.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.10
|
| 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 |
$1,809.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.10
|
| 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 |
$1,889.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.75
|
| 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 |
$1,849.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$795.60
|
| 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 |
$543.00
|
|
|
REPAIR OF SPERM DUCT
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 55400
|
| Hospital Charge Code |
6155400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$999.40 |
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$894.20
|
| Rate for Payer: First Health Commercial |
$946.80
|
| Rate for Payer: First Health Workers Compensation |
$406.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$946.80
|
| Rate for Payer: GEHA Commercial |
$736.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$946.80
|
| Rate for Payer: Multiplan All |
$957.32
|
| Rate for Payer: OMNI Networks Commercial |
$736.40
|
| Rate for Payer: One Health Plan PPO/POS |
$946.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$999.40
|
| Rate for Payer: Three Rivers Provider Network All |
$789.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$978.36
|
| Rate for Payer: Zelis Auto |
$420.80
|
| Rate for Payer: Zelis Worker's Compensation |
$287.20
|
|
|
REPAIR OF SPERM DUCT
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 55400
|
| Hospital Charge Code |
6155400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.00 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$631.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$894.20
|
| Rate for Payer: First Health Commercial |
$946.80
|
| Rate for Payer: First Health Workers Compensation |
$406.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$946.80
|
| Rate for Payer: GEHA Commercial |
$841.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$946.80
|
| 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 Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$957.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$736.40
|
| Rate for Payer: One Health Plan PPO/POS |
$946.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$999.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$789.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$978.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$420.80
|
| 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 |
$287.20
|
|
