|
REPAIR OF URETHRA INJURY
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 53502
|
| Hospital Charge Code |
6153502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.73 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna Commercial |
$849.15
|
| Rate for Payer: First Health Commercial |
$899.10
|
| Rate for Payer: First Health Workers Compensation |
$385.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$899.10
|
| Rate for Payer: GEHA Commercial |
$699.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$899.10
|
| Rate for Payer: Multiplan All |
$909.09
|
| Rate for Payer: OMNI Networks Commercial |
$699.30
|
| Rate for Payer: One Health Plan PPO/POS |
$899.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$949.05
|
| Rate for Payer: Three Rivers Provider Network All |
$749.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$929.07
|
| Rate for Payer: Zelis Auto |
$399.60
|
| Rate for Payer: Zelis Worker's Compensation |
$272.73
|
|
|
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
|
|
|
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
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 53505
|
| Hospital Charge Code |
6153505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$701.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| Rate for Payer: Multiplan All |
$911.82
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$951.90
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$931.86
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
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 URETHRAL LESION
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT 57230
|
| Hospital Charge Code |
6157230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.45 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cigna Commercial |
$848.30
|
| Rate for Payer: First Health Commercial |
$898.20
|
| Rate for Payer: First Health Workers Compensation |
$385.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$898.20
|
| Rate for Payer: GEHA Commercial |
$698.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$898.20
|
| Rate for Payer: Multiplan All |
$908.18
|
| Rate for Payer: OMNI Networks Commercial |
$698.60
|
| Rate for Payer: One Health Plan PPO/POS |
$898.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$948.10
|
| Rate for Payer: Three Rivers Provider Network All |
$748.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$928.14
|
| Rate for Payer: Zelis Auto |
$399.20
|
| Rate for Payer: Zelis Worker's Compensation |
$272.45
|
|
|
REPAIR OF URETHRAL LESION
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT 57230
|
| Hospital Charge Code |
6157230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.45 |
| Max. Negotiated Rate |
$6,038.18 |
| 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 |
$598.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cigna Commercial |
$848.30
|
| Rate for Payer: First Health Commercial |
$898.20
|
| Rate for Payer: First Health Workers Compensation |
$385.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$898.20
|
| Rate for Payer: GEHA Commercial |
$798.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$898.20
|
| 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 |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$908.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$698.60
|
| Rate for Payer: One Health Plan PPO/POS |
$898.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$948.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$748.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$928.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$399.20
|
| 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 |
$272.45
|
|
|
REPAIR OF VAGINA
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 56800
|
| Hospital Charge Code |
6156800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cigna Commercial |
$519.35
|
| Rate for Payer: First Health Commercial |
$549.90
|
| Rate for Payer: First Health Workers Compensation |
$235.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.90
|
| Rate for Payer: GEHA Commercial |
$427.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.90
|
| Rate for Payer: Multiplan All |
$556.01
|
| Rate for Payer: OMNI Networks Commercial |
$427.70
|
| Rate for Payer: One Health Plan PPO/POS |
$549.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$580.45
|
| Rate for Payer: Three Rivers Provider Network All |
$458.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$568.23
|
| Rate for Payer: Zelis Auto |
$244.40
|
| Rate for Payer: Zelis Worker's Compensation |
$166.80
|
|
|
REPAIR OF VAGINA
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 56800
|
| Hospital Charge Code |
6156800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.80 |
| 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 |
$366.60
|
| 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 |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cigna Commercial |
$519.35
|
| Rate for Payer: First Health Commercial |
$549.90
|
| Rate for Payer: First Health Workers Compensation |
$235.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.90
|
| Rate for Payer: GEHA Commercial |
$488.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.90
|
| 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 |
$556.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$427.70
|
| Rate for Payer: One Health Plan PPO/POS |
$549.90
|
| 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 |
$580.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$458.25
|
| 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 |
$568.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$244.40
|
| 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 |
$166.80
|
|
|
REPAIR OF VAGINA
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT 57260
|
| Hospital Charge Code |
6157260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.19 |
| 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 |
$1,015.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$1,439.05
|
| Rate for Payer: First Health Commercial |
$1,523.70
|
| Rate for Payer: First Health Workers Compensation |
$653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,523.70
|
| Rate for Payer: GEHA Commercial |
$1,354.40
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,523.70
|
| 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 |
$1,540.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,523.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,608.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,269.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,574.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$677.20
|
| 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 |
$462.19
|
|
|
REPAIR OF VAGINA
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
6157200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.57 |
| 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 |
$458.40
|
| 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 |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna Commercial |
$649.40
|
| Rate for Payer: First Health Commercial |
$687.60
|
| Rate for Payer: First Health Workers Compensation |
$294.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$687.60
|
| Rate for Payer: GEHA Commercial |
$611.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$687.60
|
| 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 |
$695.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$534.80
|
| Rate for Payer: One Health Plan PPO/POS |
$687.60
|
| 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 |
$725.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$573.00
|
| 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 |
$710.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$305.60
|
| 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 |
$208.57
|
|
|
REPAIR OF VAGINA
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT 57260
|
| Hospital Charge Code |
6157260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.19 |
| Max. Negotiated Rate |
$1,608.35 |
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$1,439.05
|
| Rate for Payer: First Health Commercial |
$1,523.70
|
| Rate for Payer: First Health Workers Compensation |
$653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,523.70
|
| Rate for Payer: GEHA Commercial |
$1,185.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,523.70
|
| Rate for Payer: Multiplan All |
$1,540.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,523.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,608.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,269.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,574.49
|
| Rate for Payer: Zelis Auto |
$677.20
|
| Rate for Payer: Zelis Worker's Compensation |
$462.19
|
|
|
REPAIR OF VAGINA
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
6157200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.57 |
| Max. Negotiated Rate |
$725.80 |
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna Commercial |
$649.40
|
| Rate for Payer: First Health Commercial |
$687.60
|
| Rate for Payer: First Health Workers Compensation |
$294.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$687.60
|
| Rate for Payer: GEHA Commercial |
$534.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$687.60
|
| Rate for Payer: Multiplan All |
$695.24
|
| Rate for Payer: OMNI Networks Commercial |
$534.80
|
| Rate for Payer: One Health Plan PPO/POS |
$687.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$725.80
|
| Rate for Payer: Three Rivers Provider Network All |
$573.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$710.52
|
| Rate for Payer: Zelis Auto |
$305.60
|
| Rate for Payer: Zelis Worker's Compensation |
$208.57
|
|
|
REPAIR OF WEB FINGER
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 26560
|
| Hospital Charge Code |
6126560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$1,046.90 |
| Rate for Payer: Cash Price |
$661.20
|
| Rate for Payer: Cigna Commercial |
$936.70
|
| Rate for Payer: First Health Commercial |
$991.80
|
| Rate for Payer: First Health Workers Compensation |
$425.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$991.80
|
| Rate for Payer: GEHA Commercial |
$771.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$991.80
|
| Rate for Payer: Multiplan All |
$1,002.82
|
| Rate for Payer: OMNI Networks Commercial |
$771.40
|
| Rate for Payer: One Health Plan PPO/POS |
$991.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,046.90
|
| Rate for Payer: Three Rivers Provider Network All |
$826.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,024.86
|
| Rate for Payer: Zelis Auto |
$440.80
|
| Rate for Payer: Zelis Worker's Compensation |
$300.85
|
|
|
REPAIR OF WEB FINGER
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
CPT 26561
|
| Hospital Charge Code |
6126561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$506.42 |
| Max. Negotiated Rate |
$1,762.25 |
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$1,576.75
|
| Rate for Payer: First Health Commercial |
$1,669.50
|
| Rate for Payer: First Health Workers Compensation |
$716.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,669.50
|
| Rate for Payer: GEHA Commercial |
$1,298.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,669.50
|
| Rate for Payer: Multiplan All |
$1,688.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,298.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,669.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,762.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,391.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,725.15
|
| Rate for Payer: Zelis Auto |
$742.00
|
| Rate for Payer: Zelis Worker's Compensation |
$506.42
|
|
|
REPAIR OF WEB FINGER
|
Facility
|
OP
|
$2,710.00
|
|
|
Service Code
|
CPT 26562
|
| Hospital Charge Code |
6126562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$739.83 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,626.00
|
| Rate for Payer: Cash Price |
$1,626.00
|
| Rate for Payer: Cigna Commercial |
$2,303.50
|
| Rate for Payer: First Health Commercial |
$2,439.00
|
| Rate for Payer: First Health Workers Compensation |
$1,046.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,439.00
|
| Rate for Payer: GEHA Commercial |
$2,168.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,439.00
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,466.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,897.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,439.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,574.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$2,032.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,520.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$1,084.00
|
| 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 |
$739.83
|
|
|
REPAIR OF WEB FINGER
|
Facility
|
IP
|
$2,710.00
|
|
|
Service Code
|
CPT 26562
|
| Hospital Charge Code |
6126562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$739.83 |
| Max. Negotiated Rate |
$2,574.50 |
| Rate for Payer: Cash Price |
$1,626.00
|
| Rate for Payer: Cigna Commercial |
$2,303.50
|
| Rate for Payer: First Health Commercial |
$2,439.00
|
| Rate for Payer: First Health Workers Compensation |
$1,046.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,439.00
|
| Rate for Payer: GEHA Commercial |
$1,897.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,439.00
|
| Rate for Payer: Multiplan All |
$2,466.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,897.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,439.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,574.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,032.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,520.30
|
| Rate for Payer: Zelis Auto |
$1,084.00
|
| Rate for Payer: Zelis Worker's Compensation |
$739.83
|
|
|
REPAIR OF WEB FINGER
|
Facility
|
OP
|
$1,855.00
|
|
|
Service Code
|
CPT 26561
|
| Hospital Charge Code |
6126561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$506.42 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,113.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$1,576.75
|
| Rate for Payer: First Health Commercial |
$1,669.50
|
| Rate for Payer: First Health Workers Compensation |
$716.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,669.50
|
| Rate for Payer: GEHA Commercial |
$1,484.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,669.50
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,688.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,298.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,669.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,762.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,391.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,725.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$742.00
|
| 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 |
$506.42
|
|
|
REPAIR OF WEB FINGER
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 26560
|
| Hospital Charge Code |
6126560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$661.20
|
| Rate for Payer: Cash Price |
$661.20
|
| Rate for Payer: Cigna Commercial |
$936.70
|
| Rate for Payer: First Health Commercial |
$991.80
|
| Rate for Payer: First Health Workers Compensation |
$425.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$991.80
|
| Rate for Payer: GEHA Commercial |
$881.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$991.80
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,002.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$771.40
|
| Rate for Payer: One Health Plan PPO/POS |
$991.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,046.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$826.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,024.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$440.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$300.85
|
|
|
REPAIR PALATE PHARYNX/UVULA
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
CPT 42145
|
| Hospital Charge Code |
6142145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.40 |
| Max. Negotiated Rate |
$11,234.32 |
| 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 |
$871.20
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna Commercial |
$1,234.20
|
| Rate for Payer: First Health Commercial |
$1,306.80
|
| Rate for Payer: First Health Workers Compensation |
$560.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,306.80
|
| Rate for Payer: GEHA Commercial |
$1,161.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,306.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,321.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,016.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,306.80
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,379.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,350.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$580.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$396.40
|
|
|
REPAIR PALATE PHARYNX/UVULA
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
CPT 42145
|
| Hospital Charge Code |
6142145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.40 |
| Max. Negotiated Rate |
$1,379.40 |
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna Commercial |
$1,234.20
|
| Rate for Payer: First Health Commercial |
$1,306.80
|
| Rate for Payer: First Health Workers Compensation |
$560.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,306.80
|
| Rate for Payer: GEHA Commercial |
$1,016.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,306.80
|
| Rate for Payer: Multiplan All |
$1,321.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,016.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,306.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,379.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,350.36
|
| Rate for Payer: Zelis Auto |
$580.80
|
| Rate for Payer: Zelis Worker's Compensation |
$396.40
|
|
|
REPAIR PARAVAG DEFECT LAP
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 57423
|
| Hospital Charge Code |
6157423
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$506.96 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,114.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$1,114.20
|
| Rate for Payer: Cash Price |
$1,114.20
|
| Rate for Payer: Cigna Commercial |
$1,578.45
|
| Rate for Payer: First Health Commercial |
$1,671.30
|
| Rate for Payer: First Health Workers Compensation |
$716.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,671.30
|
| Rate for Payer: GEHA Commercial |
$1,485.60
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,671.30
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$1,689.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,299.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,671.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,764.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,392.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,727.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$742.80
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$506.96
|
|
|
REPAIR PARAVAG DEFECT LAP
|
Facility
|
IP
|
$1,857.00
|
|
|
Service Code
|
CPT 57423
|
| Hospital Charge Code |
6157423
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$506.96 |
| Max. Negotiated Rate |
$1,764.15 |
| Rate for Payer: Cash Price |
$1,114.20
|
| Rate for Payer: Cigna Commercial |
$1,578.45
|
| Rate for Payer: First Health Commercial |
$1,671.30
|
| Rate for Payer: First Health Workers Compensation |
$716.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,671.30
|
| Rate for Payer: GEHA Commercial |
$1,299.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,671.30
|
| Rate for Payer: Multiplan All |
$1,689.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,299.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,671.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,764.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,392.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,727.01
|
| Rate for Payer: Zelis Auto |
$742.80
|
| Rate for Payer: Zelis Worker's Compensation |
$506.96
|
|
|
REPAIR PARAVAG DEFECT OPEN
|
Facility
|
IP
|
$1,661.00
|
|
|
Service Code
|
CPT 57284
|
| Hospital Charge Code |
6157284
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$453.45 |
| Max. Negotiated Rate |
$1,577.95 |
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$1,411.85
|
| Rate for Payer: First Health Commercial |
$1,494.90
|
| Rate for Payer: First Health Workers Compensation |
$641.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,494.90
|
| Rate for Payer: GEHA Commercial |
$1,162.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,494.90
|
| Rate for Payer: Multiplan All |
$1,511.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,162.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,494.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,577.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,245.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,544.73
|
| Rate for Payer: Zelis Auto |
$664.40
|
| Rate for Payer: Zelis Worker's Compensation |
$453.45
|
|
|
REPAIR PARAVAG DEFECT OPEN
|
Facility
|
OP
|
$1,661.00
|
|
|
Service Code
|
CPT 57284
|
| Hospital Charge Code |
6157284
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$453.45 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$996.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$1,411.85
|
| Rate for Payer: First Health Commercial |
$1,494.90
|
| Rate for Payer: First Health Workers Compensation |
$641.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,494.90
|
| Rate for Payer: GEHA Commercial |
$1,328.80
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,494.90
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,511.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,162.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,494.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,577.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,245.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,544.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$664.40
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$453.45
|
|
