|
REPAIR OF STERNUM SEPARATION
|
Facility
|
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 21750
|
| Hospital Charge Code |
6121750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$392.30 |
| Max. Negotiated Rate |
$1,365.15 |
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cigna Commercial |
$1,221.45
|
| Rate for Payer: First Health Commercial |
$1,293.30
|
| Rate for Payer: First Health Workers Compensation |
$554.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,293.30
|
| Rate for Payer: GEHA Commercial |
$1,005.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,293.30
|
| Rate for Payer: Multiplan All |
$1,307.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,293.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,365.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,336.41
|
| Rate for Payer: Zelis Auto |
$574.80
|
| Rate for Payer: Zelis Worker's Compensation |
$392.30
|
|
|
REPAIR OF STERNUM SEPARATION
|
Facility
|
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 21750
|
| Hospital Charge Code |
6121750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.25 |
| Max. Negotiated Rate |
$1,365.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cigna Commercial |
$1,221.45
|
| Rate for Payer: First Health Commercial |
$1,293.30
|
| Rate for Payer: First Health Workers Compensation |
$554.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,293.30
|
| Rate for Payer: GEHA Commercial |
$1,149.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,293.30
|
| Rate for Payer: Humana ChoiceCare |
$373.62
|
| Rate for Payer: Multiplan All |
$1,307.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$862.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,293.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,365.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,264.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$359.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,336.41
|
| Rate for Payer: Zelis Auto |
$574.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.50
|
| Rate for Payer: Zelis Worker's Compensation |
$392.30
|
|
|
REPAIR OF STOMACH LESION
|
Facility
|
IP
|
$2,862.00
|
|
|
Service Code
|
CPT 43840
|
| Hospital Charge Code |
6143840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$781.33 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Cash Price |
$1,717.20
|
| Rate for Payer: Cigna Commercial |
$2,432.70
|
| Rate for Payer: First Health Commercial |
$2,575.80
|
| Rate for Payer: First Health Workers Compensation |
$1,105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,575.80
|
| Rate for Payer: GEHA Commercial |
$2,003.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,575.80
|
| Rate for Payer: Multiplan All |
$2,604.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,003.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,575.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,718.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,146.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,661.66
|
| Rate for Payer: Zelis Auto |
$1,144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$781.33
|
|
|
REPAIR OF STOMACH LESION
|
Facility
|
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 43840
|
| Hospital Charge Code |
6143840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$715.50 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,717.20
|
| Rate for Payer: Cash Price |
$1,717.20
|
| Rate for Payer: Cigna Commercial |
$2,432.70
|
| Rate for Payer: First Health Commercial |
$2,575.80
|
| Rate for Payer: First Health Workers Compensation |
$1,105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,575.80
|
| Rate for Payer: GEHA Commercial |
$2,289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,575.80
|
| Rate for Payer: Humana ChoiceCare |
$744.12
|
| Rate for Payer: Multiplan All |
$2,604.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,717.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,003.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,575.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,718.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,146.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,518.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$715.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,661.66
|
| Rate for Payer: Zelis Auto |
$1,144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,431.00
|
| Rate for Payer: Zelis Worker's Compensation |
$781.33
|
|
|
REPAIR OF THIGH
|
Facility
|
IP
|
$2,423.00
|
|
|
Service Code
|
CPT 27470
|
| Hospital Charge Code |
6127470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$661.48 |
| Max. Negotiated Rate |
$2,301.85 |
| Rate for Payer: Cash Price |
$1,453.80
|
| Rate for Payer: Cigna Commercial |
$2,059.55
|
| Rate for Payer: First Health Commercial |
$2,180.70
|
| Rate for Payer: First Health Workers Compensation |
$935.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,180.70
|
| Rate for Payer: GEHA Commercial |
$1,696.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,180.70
|
| Rate for Payer: Multiplan All |
$2,204.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,696.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,180.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,301.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,817.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,253.39
|
| Rate for Payer: Zelis Auto |
$969.20
|
| Rate for Payer: Zelis Worker's Compensation |
$661.48
|
|
|
REPAIR OF THIGH
|
Facility
|
OP
|
$2,423.00
|
|
|
Service Code
|
CPT 27470
|
| Hospital Charge Code |
6127470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$605.75 |
| Max. Negotiated Rate |
$2,301.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,453.80
|
| Rate for Payer: Cash Price |
$1,453.80
|
| Rate for Payer: Cigna Commercial |
$2,059.55
|
| Rate for Payer: First Health Commercial |
$2,180.70
|
| Rate for Payer: First Health Workers Compensation |
$935.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,180.70
|
| Rate for Payer: GEHA Commercial |
$1,938.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,180.70
|
| Rate for Payer: Humana ChoiceCare |
$629.98
|
| Rate for Payer: Multiplan All |
$2,204.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,453.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,696.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,180.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,301.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,817.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,132.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$605.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,253.39
|
| Rate for Payer: Zelis Auto |
$969.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,211.50
|
| Rate for Payer: Zelis Worker's Compensation |
$661.48
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
6127385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.32 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$699.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$991.10
|
| Rate for Payer: First Health Commercial |
$1,049.40
|
| Rate for Payer: First Health Workers Compensation |
$450.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,049.40
|
| Rate for Payer: GEHA Commercial |
$932.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,049.40
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,061.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$816.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,049.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,107.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$874.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,084.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$466.40
|
| 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 |
$318.32
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
6127385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.32 |
| Max. Negotiated Rate |
$1,107.70 |
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$991.10
|
| Rate for Payer: First Health Commercial |
$1,049.40
|
| Rate for Payer: First Health Workers Compensation |
$450.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,049.40
|
| Rate for Payer: GEHA Commercial |
$816.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,049.40
|
| Rate for Payer: Multiplan All |
$1,061.06
|
| Rate for Payer: OMNI Networks Commercial |
$816.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,049.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,107.70
|
| Rate for Payer: Three Rivers Provider Network All |
$874.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,084.38
|
| Rate for Payer: Zelis Auto |
$466.40
|
| Rate for Payer: Zelis Worker's Compensation |
$318.32
|
|
|
REPAIR OF TIBIA
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
CPT 27720
|
| Hospital Charge Code |
6127720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.85 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,078.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Cigna Commercial |
$1,528.30
|
| Rate for Payer: First Health Commercial |
$1,618.20
|
| Rate for Payer: First Health Workers Compensation |
$694.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,618.20
|
| Rate for Payer: GEHA Commercial |
$1,438.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,618.20
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,636.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,258.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,618.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,708.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,348.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,672.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$719.20
|
| 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 |
$490.85
|
|
|
REPAIR OF TIBIA
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
CPT 27720
|
| Hospital Charge Code |
6127720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.85 |
| Max. Negotiated Rate |
$1,708.10 |
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Cigna Commercial |
$1,528.30
|
| Rate for Payer: First Health Commercial |
$1,618.20
|
| Rate for Payer: First Health Workers Compensation |
$694.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,618.20
|
| Rate for Payer: GEHA Commercial |
$1,258.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,618.20
|
| Rate for Payer: Multiplan All |
$1,636.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,258.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,618.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,708.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,348.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,672.14
|
| Rate for Payer: Zelis Auto |
$719.20
|
| Rate for Payer: Zelis Worker's Compensation |
$490.85
|
|
|
REPAIR OF TIBIA EPIPHYSIS
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 27730
|
| Hospital Charge Code |
6127730
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.59 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: First Health Workers Compensation |
$450.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$816.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
| Rate for Payer: Zelis Worker's Compensation |
$318.59
|
|
|
REPAIR OF TIBIA EPIPHYSIS
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT 27730
|
| Hospital Charge Code |
6127730
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.59 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$700.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: First Health Workers Compensation |
$450.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$933.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$466.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$318.59
|
|
|
REPAIR OF TOE DISLOCATION
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 28675
|
| Hospital Charge Code |
6128675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$323.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$228.50
|
|
|
REPAIR OF TOE DISLOCATION
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 28675
|
| Hospital Charge Code |
6128675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$323.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$669.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$228.50
|
|
|
REPAIR OF URETER
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
CPT 50900
|
| Hospital Charge Code |
6150900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.00 |
| Max. Negotiated Rate |
$1,691.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,513.00
|
| Rate for Payer: First Health Commercial |
$1,602.00
|
| Rate for Payer: First Health Workers Compensation |
$687.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,602.00
|
| Rate for Payer: GEHA Commercial |
$1,424.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,602.00
|
| Rate for Payer: Humana ChoiceCare |
$462.80
|
| Rate for Payer: Multiplan All |
$1,619.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,068.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,246.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,602.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,691.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,335.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,566.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$445.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,655.40
|
| Rate for Payer: Zelis Auto |
$712.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$890.00
|
| Rate for Payer: Zelis Worker's Compensation |
$485.94
|
|
|
REPAIR OF URETER
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
CPT 50900
|
| Hospital Charge Code |
6150900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.94 |
| Max. Negotiated Rate |
$1,691.00 |
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,513.00
|
| Rate for Payer: First Health Commercial |
$1,602.00
|
| Rate for Payer: First Health Workers Compensation |
$687.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,602.00
|
| Rate for Payer: GEHA Commercial |
$1,246.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,602.00
|
| Rate for Payer: Multiplan All |
$1,619.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,246.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,602.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,691.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,335.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,655.40
|
| Rate for Payer: Zelis Auto |
$712.00
|
| Rate for Payer: Zelis Worker's Compensation |
$485.94
|
|
|
REPAIR OF URETER LESION
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 51535
|
| Hospital Charge Code |
6151535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.44 |
| Max. Negotiated Rate |
$1,525.70 |
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$1,365.10
|
| Rate for Payer: First Health Commercial |
$1,445.40
|
| Rate for Payer: First Health Workers Compensation |
$620.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.40
|
| Rate for Payer: GEHA Commercial |
$1,124.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.40
|
| Rate for Payer: Multiplan All |
$1,461.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,525.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,493.58
|
| Rate for Payer: Zelis Auto |
$642.40
|
| Rate for Payer: Zelis Worker's Compensation |
$438.44
|
|
|
REPAIR OF URETER LESION
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 51535
|
| Hospital Charge Code |
6151535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.44 |
| 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 |
$963.60
|
| 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 |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$1,365.10
|
| Rate for Payer: First Health Commercial |
$1,445.40
|
| Rate for Payer: First Health Workers Compensation |
$620.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.40
|
| Rate for Payer: GEHA Commercial |
$1,284.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.40
|
| 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 |
$1,461.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.40
|
| 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 |
$1,525.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.50
|
| 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 |
$1,493.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$642.40
|
| 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 |
$438.44
|
|
|
REPAIR OF URETHRA DEFECT
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
CPT 53520
|
| Hospital Charge Code |
6153520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.77 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$685.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cigna Commercial |
$970.70
|
| Rate for Payer: First Health Commercial |
$1,027.80
|
| Rate for Payer: First Health Workers Compensation |
$440.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,027.80
|
| Rate for Payer: GEHA Commercial |
$913.60
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,027.80
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,039.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$799.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,027.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,084.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$856.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$456.80
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$311.77
|
|
|
REPAIR OF URETHRA DEFECT
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 53520
|
| Hospital Charge Code |
6153520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.77 |
| Max. Negotiated Rate |
$1,084.90 |
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cigna Commercial |
$970.70
|
| Rate for Payer: First Health Commercial |
$1,027.80
|
| Rate for Payer: First Health Workers Compensation |
$440.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,027.80
|
| Rate for Payer: GEHA Commercial |
$799.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,027.80
|
| Rate for Payer: Multiplan All |
$1,039.22
|
| Rate for Payer: OMNI Networks Commercial |
$799.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,027.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,084.90
|
| Rate for Payer: Three Rivers Provider Network All |
$856.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.06
|
| Rate for Payer: Zelis Auto |
$456.80
|
| Rate for Payer: Zelis Worker's Compensation |
$311.77
|
|
|
REPAIR OF URETHRA DEFECT
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 53275
|
| Hospital Charge Code |
6153275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: First Health Workers Compensation |
$260.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$270.00
|
| 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 |
$184.28
|
|
|
REPAIR OF URETHRA DEFECT
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 53275
|
| Hospital Charge Code |
6153275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: First Health Workers Compensation |
$260.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Worker's Compensation |
$184.28
|
|
|
REPAIR OF URETHRA INJURY
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 53510
|
| Hospital Charge Code |
6153510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.35 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$778.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$1,103.30
|
| Rate for Payer: First Health Commercial |
$1,168.20
|
| Rate for Payer: First Health Workers Compensation |
$501.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,168.20
|
| Rate for Payer: GEHA Commercial |
$1,038.40
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,168.20
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,181.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$908.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,168.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,233.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$973.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,207.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$519.20
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$354.35
|
|
|
REPAIR OF URETHRA INJURY
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 53510
|
| Hospital Charge Code |
6153510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.35 |
| Max. Negotiated Rate |
$1,233.10 |
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$1,103.30
|
| Rate for Payer: First Health Commercial |
$1,168.20
|
| Rate for Payer: First Health Workers Compensation |
$501.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,168.20
|
| Rate for Payer: GEHA Commercial |
$908.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,168.20
|
| Rate for Payer: Multiplan All |
$1,181.18
|
| Rate for Payer: OMNI Networks Commercial |
$908.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,168.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,233.10
|
| Rate for Payer: Three Rivers Provider Network All |
$973.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,207.14
|
| Rate for Payer: Zelis Auto |
$519.20
|
| Rate for Payer: Zelis Worker's Compensation |
$354.35
|
|
|
REPAIR OF URETHRA INJURY
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 53515
|
| Hospital Charge Code |
6153515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.17 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$982.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cigna Commercial |
$1,392.30
|
| Rate for Payer: First Health Commercial |
$1,474.20
|
| Rate for Payer: First Health Workers Compensation |
$632.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,474.20
|
| Rate for Payer: GEHA Commercial |
$1,310.40
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,474.20
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,490.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,146.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,474.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,556.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,228.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,523.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$655.20
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$447.17
|
|
