|
REPAIR PARAVAG DEFECT VAG
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 57285
|
| Hospital Charge Code |
6157285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.19 |
| Max. Negotiated Rate |
$1,298.65 |
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cigna Commercial |
$1,161.95
|
| Rate for Payer: First Health Commercial |
$1,230.30
|
| Rate for Payer: First Health Workers Compensation |
$527.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,230.30
|
| Rate for Payer: GEHA Commercial |
$956.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,230.30
|
| Rate for Payer: Multiplan All |
$1,243.97
|
| Rate for Payer: OMNI Networks Commercial |
$956.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,230.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,298.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,025.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,271.31
|
| Rate for Payer: Zelis Auto |
$546.80
|
| Rate for Payer: Zelis Worker's Compensation |
$373.19
|
|
|
REPAIR PARAVAG DEFECT VAG
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 57285
|
| Hospital Charge Code |
6157285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.19 |
| Max. Negotiated Rate |
$14,043.34 |
| 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 |
$820.20
|
| 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 |
$7,021.67
|
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cigna Commercial |
$1,161.95
|
| Rate for Payer: First Health Commercial |
$1,230.30
|
| Rate for Payer: First Health Workers Compensation |
$527.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,230.30
|
| Rate for Payer: GEHA Commercial |
$1,093.60
|
| Rate for Payer: GEHA Medicare |
$7,021.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,230.30
|
| Rate for Payer: Humana ChoiceCare |
$7,723.84
|
| Rate for Payer: Humana Medicare Advantage |
$7,021.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,796.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,021.67
|
| Rate for Payer: Multiplan All |
$1,243.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,936.84
|
| Rate for Payer: OMNI Networks Commercial |
$956.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,230.30
|
| 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 |
$7,021.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,298.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,043.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,025.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,881.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,021.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,271.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,021.67
|
| Rate for Payer: Zelis Auto |
$546.80
|
| Rate for Payer: Zelis Medicare |
$5,968.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$373.19
|
|
|
REPAIR PENIS
|
Facility
|
OP
|
$2,011.00
|
|
|
Service Code
|
CPT 54385
|
| Hospital Charge Code |
6154385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.00 |
| Max. Negotiated Rate |
$3,890.28 |
| 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 |
$1,206.60
|
| 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 |
$1,945.14
|
| Rate for Payer: Cash Price |
$1,206.60
|
| Rate for Payer: Cash Price |
$1,206.60
|
| Rate for Payer: Cigna Commercial |
$1,709.35
|
| Rate for Payer: First Health Commercial |
$1,809.90
|
| Rate for Payer: First Health Workers Compensation |
$776.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.90
|
| Rate for Payer: GEHA Commercial |
$1,608.80
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.90
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,830.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.90
|
| 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 |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,910.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$1,508.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,870.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$804.40
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$549.00
|
|
|
REPAIR PENIS
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 54380
|
| Hospital Charge Code |
6154380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$449.36 |
| Max. Negotiated Rate |
$1,563.70 |
| Rate for Payer: Cash Price |
$987.60
|
| Rate for Payer: Cigna Commercial |
$1,399.10
|
| Rate for Payer: First Health Commercial |
$1,481.40
|
| Rate for Payer: First Health Workers Compensation |
$635.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,481.40
|
| Rate for Payer: GEHA Commercial |
$1,152.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,481.40
|
| Rate for Payer: Multiplan All |
$1,497.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,152.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,481.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,563.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,234.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,530.78
|
| Rate for Payer: Zelis Auto |
$658.40
|
| Rate for Payer: Zelis Worker's Compensation |
$449.36
|
|
|
REPAIR PENIS
|
Facility
|
IP
|
$2,011.00
|
|
|
Service Code
|
CPT 54385
|
| Hospital Charge Code |
6154385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.00 |
| Max. Negotiated Rate |
$1,910.45 |
| Rate for Payer: Cash Price |
$1,206.60
|
| Rate for Payer: Cigna Commercial |
$1,709.35
|
| Rate for Payer: First Health Commercial |
$1,809.90
|
| Rate for Payer: First Health Workers Compensation |
$776.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.90
|
| Rate for Payer: GEHA Commercial |
$1,407.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.90
|
| Rate for Payer: Multiplan All |
$1,830.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,910.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,508.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,870.23
|
| Rate for Payer: Zelis Auto |
$804.40
|
| Rate for Payer: Zelis Worker's Compensation |
$549.00
|
|
|
REPAIR PENIS
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 54380
|
| Hospital Charge Code |
6154380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$449.36 |
| Max. Negotiated Rate |
$3,890.28 |
| 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 |
$987.60
|
| 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 |
$1,945.14
|
| Rate for Payer: Cash Price |
$987.60
|
| Rate for Payer: Cash Price |
$987.60
|
| Rate for Payer: Cigna Commercial |
$1,399.10
|
| Rate for Payer: First Health Commercial |
$1,481.40
|
| Rate for Payer: First Health Workers Compensation |
$635.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,481.40
|
| Rate for Payer: GEHA Commercial |
$1,316.80
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,481.40
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,497.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,152.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,481.40
|
| 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 |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,563.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$1,234.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,530.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$658.40
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$449.36
|
|
|
REPAIR PENIS AND BLADDER
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
CPT 54390
|
| Hospital Charge Code |
6154390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$673.00 |
| Max. Negotiated Rate |
$2,557.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,615.20
|
| Rate for Payer: Cash Price |
$1,615.20
|
| Rate for Payer: Cigna Commercial |
$2,288.20
|
| Rate for Payer: First Health Commercial |
$2,422.80
|
| Rate for Payer: First Health Workers Compensation |
$1,039.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,422.80
|
| Rate for Payer: GEHA Commercial |
$2,153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,422.80
|
| Rate for Payer: Humana ChoiceCare |
$699.92
|
| Rate for Payer: Multiplan All |
$2,449.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,615.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,884.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,422.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,557.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,019.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,368.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$673.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,503.56
|
| Rate for Payer: Zelis Auto |
$1,076.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,346.00
|
| Rate for Payer: Zelis Worker's Compensation |
$734.92
|
|
|
REPAIR PENIS AND BLADDER
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
CPT 54390
|
| Hospital Charge Code |
6154390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$734.92 |
| Max. Negotiated Rate |
$2,557.40 |
| Rate for Payer: Cash Price |
$1,615.20
|
| Rate for Payer: Cigna Commercial |
$2,288.20
|
| Rate for Payer: First Health Commercial |
$2,422.80
|
| Rate for Payer: First Health Workers Compensation |
$1,039.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,422.80
|
| Rate for Payer: GEHA Commercial |
$1,884.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,422.80
|
| Rate for Payer: Multiplan All |
$2,449.72
|
| Rate for Payer: OMNI Networks Commercial |
$1,884.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,422.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,557.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,019.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,503.56
|
| Rate for Payer: Zelis Auto |
$1,076.80
|
| Rate for Payer: Zelis Worker's Compensation |
$734.92
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,730.88 |
| 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 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: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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: New Mexico Health Connections Medicare |
$11,531.54
|
| 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 Worker's Compensation |
$13,566.52
|
| 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: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
REPAIR RADIUS OR ULNA
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
CPT 25400
|
| Hospital Charge Code |
6125400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$449.08 |
| 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 |
$987.00
|
| 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 |
$987.00
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cigna Commercial |
$1,398.25
|
| Rate for Payer: First Health Commercial |
$1,480.50
|
| Rate for Payer: First Health Workers Compensation |
$635.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,480.50
|
| Rate for Payer: GEHA Commercial |
$1,316.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,480.50
|
| 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 |
$1,496.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,151.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,480.50
|
| 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 |
$1,562.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.75
|
| 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 |
$1,529.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$658.00
|
| 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 |
$449.08
|
|
|
REPAIR RADIUS OR ULNA
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
CPT 25400
|
| Hospital Charge Code |
6125400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$449.08 |
| Max. Negotiated Rate |
$1,562.75 |
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cigna Commercial |
$1,398.25
|
| Rate for Payer: First Health Commercial |
$1,480.50
|
| Rate for Payer: First Health Workers Compensation |
$635.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,480.50
|
| Rate for Payer: GEHA Commercial |
$1,151.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,480.50
|
| Rate for Payer: Multiplan All |
$1,496.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,151.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,480.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,562.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,529.85
|
| Rate for Payer: Zelis Auto |
$658.00
|
| Rate for Payer: Zelis Worker's Compensation |
$449.08
|
|
|
REPAIR RADIUS & ULNA
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 25415
|
| Hospital Charge Code |
6125415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$540.27 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: First Health Workers Compensation |
$764.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,385.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: Zelis Auto |
$791.60
|
| Rate for Payer: Zelis Worker's Compensation |
$540.27
|
|
|
REPAIR RADIUS & ULNA
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 25415
|
| Hospital Charge Code |
6125415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$540.27 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,187.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: First Health Workers Compensation |
$764.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,583.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$791.60
|
| 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 |
$540.27
|
|
|
REPAIR RECT/BLADDER FISTULA
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
CPT 45800
|
| Hospital Charge Code |
6145800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$685.50 |
| Max. Negotiated Rate |
$2,385.45 |
| Rate for Payer: Cash Price |
$1,506.60
|
| Rate for Payer: Cigna Commercial |
$2,134.35
|
| Rate for Payer: First Health Commercial |
$2,259.90
|
| Rate for Payer: First Health Workers Compensation |
$969.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,259.90
|
| Rate for Payer: GEHA Commercial |
$1,757.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,259.90
|
| Rate for Payer: Multiplan All |
$2,285.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,757.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,259.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,385.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,883.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,335.23
|
| Rate for Payer: Zelis Auto |
$1,004.40
|
| Rate for Payer: Zelis Worker's Compensation |
$685.50
|
|
|
REPAIR RECT/BLADDER FISTULA
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
CPT 45800
|
| Hospital Charge Code |
6145800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$627.75 |
| Max. Negotiated Rate |
$2,385.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,506.60
|
| Rate for Payer: Cigna Commercial |
$2,134.35
|
| Rate for Payer: First Health Commercial |
$2,259.90
|
| Rate for Payer: First Health Workers Compensation |
$969.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,259.90
|
| Rate for Payer: GEHA Commercial |
$2,008.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,259.90
|
| Rate for Payer: Humana ChoiceCare |
$652.86
|
| Rate for Payer: Multiplan All |
$2,285.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,506.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,757.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,259.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,385.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,883.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,209.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,335.23
|
| Rate for Payer: Zelis Auto |
$1,004.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,255.50
|
| Rate for Payer: Zelis Worker's Compensation |
$685.50
|
|
|
REPAIR RECTOURETHRAL FISTULA
|
Facility
|
OP
|
$2,474.00
|
|
|
Service Code
|
CPT 45820
|
| Hospital Charge Code |
6145820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$618.50 |
| Max. Negotiated Rate |
$2,350.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,484.40
|
| Rate for Payer: Cash Price |
$1,484.40
|
| Rate for Payer: Cigna Commercial |
$2,102.90
|
| Rate for Payer: First Health Commercial |
$2,226.60
|
| Rate for Payer: First Health Workers Compensation |
$955.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,226.60
|
| Rate for Payer: GEHA Commercial |
$1,979.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,226.60
|
| Rate for Payer: Humana ChoiceCare |
$643.24
|
| Rate for Payer: Multiplan All |
$2,251.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,484.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,731.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,226.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,350.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,855.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,177.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$618.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,300.82
|
| Rate for Payer: Zelis Auto |
$989.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,237.00
|
| Rate for Payer: Zelis Worker's Compensation |
$675.40
|
|
|
REPAIR RECTOURETHRAL FISTULA
|
Facility
|
IP
|
$2,474.00
|
|
|
Service Code
|
CPT 45820
|
| Hospital Charge Code |
6145820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$675.40 |
| Max. Negotiated Rate |
$2,350.30 |
| Rate for Payer: Cash Price |
$1,484.40
|
| Rate for Payer: Cigna Commercial |
$2,102.90
|
| Rate for Payer: First Health Commercial |
$2,226.60
|
| Rate for Payer: First Health Workers Compensation |
$955.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,226.60
|
| Rate for Payer: GEHA Commercial |
$1,731.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,226.60
|
| Rate for Payer: Multiplan All |
$2,251.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,731.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,226.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,350.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,855.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,300.82
|
| Rate for Payer: Zelis Auto |
$989.60
|
| Rate for Payer: Zelis Worker's Compensation |
$675.40
|
|
|
REPAIR RECTUM/REMOVE SIGMOID
|
Facility
|
IP
|
$3,049.00
|
|
|
Service Code
|
CPT 45550
|
| Hospital Charge Code |
6145550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$832.38 |
| Max. Negotiated Rate |
$2,896.55 |
| Rate for Payer: Cash Price |
$1,829.40
|
| Rate for Payer: Cigna Commercial |
$2,591.65
|
| Rate for Payer: First Health Commercial |
$2,744.10
|
| Rate for Payer: First Health Workers Compensation |
$1,177.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,744.10
|
| Rate for Payer: GEHA Commercial |
$2,134.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,744.10
|
| Rate for Payer: Multiplan All |
$2,774.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,134.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,744.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,896.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,835.57
|
| Rate for Payer: Zelis Auto |
$1,219.60
|
| Rate for Payer: Zelis Worker's Compensation |
$832.38
|
|
|
REPAIR RECTUM/REMOVE SIGMOID
|
Facility
|
OP
|
$3,049.00
|
|
|
Service Code
|
CPT 45550
|
| Hospital Charge Code |
6145550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$762.25 |
| Max. Negotiated Rate |
$2,896.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,829.40
|
| Rate for Payer: Cash Price |
$1,829.40
|
| Rate for Payer: Cigna Commercial |
$2,591.65
|
| Rate for Payer: First Health Commercial |
$2,744.10
|
| Rate for Payer: First Health Workers Compensation |
$1,177.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,744.10
|
| Rate for Payer: GEHA Commercial |
$2,439.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,744.10
|
| Rate for Payer: Humana ChoiceCare |
$792.74
|
| Rate for Payer: Multiplan All |
$2,774.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,829.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,134.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,744.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,896.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,683.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$762.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,835.57
|
| Rate for Payer: Zelis Auto |
$1,219.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,524.50
|
| Rate for Payer: Zelis Worker's Compensation |
$832.38
|
|
|
REPAIR RECTUM & VAGINA
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
6157250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$960.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
REPAIR RECTUM & VAGINA
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
6157250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| 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 |
$823.20
|
| 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 |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$1,097.60
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| 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 |
$1,248.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| 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 |
$1,303.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| 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 |
$1,275.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$548.80
|
| 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 |
$374.56
|
|
|
REPAIR RECTUM-VAGINA FISTULA
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT 57300
|
| Hospital Charge Code |
6157300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$1,090.60 |
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: First Health Workers Compensation |
$443.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$803.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| Rate for Payer: Multiplan All |
$1,044.68
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,090.60
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,067.64
|
| Rate for Payer: Zelis Auto |
$459.20
|
| Rate for Payer: Zelis Worker's Compensation |
$313.40
|
|
|
REPAIR RECTUM-VAGINA FISTULA
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 57305
|
| Hospital Charge Code |
6157305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.75 |
| Max. Negotiated Rate |
$1,834.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,158.60
|
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$1,641.35
|
| Rate for Payer: First Health Commercial |
$1,737.90
|
| Rate for Payer: First Health Workers Compensation |
$745.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.90
|
| Rate for Payer: GEHA Commercial |
$1,544.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.90
|
| Rate for Payer: Humana ChoiceCare |
$502.06
|
| Rate for Payer: Multiplan All |
$1,757.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,834.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,448.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,699.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$482.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,795.83
|
| Rate for Payer: Zelis Auto |
$772.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$965.50
|
| Rate for Payer: Zelis Worker's Compensation |
$527.16
|
|
|
REPAIR RECTUM-VAGINA FISTULA
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 57305
|
| Hospital Charge Code |
6157305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.16 |
| Max. Negotiated Rate |
$1,834.45 |
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$1,641.35
|
| Rate for Payer: First Health Commercial |
$1,737.90
|
| Rate for Payer: First Health Workers Compensation |
$745.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.90
|
| Rate for Payer: GEHA Commercial |
$1,351.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.90
|
| Rate for Payer: Multiplan All |
$1,757.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,834.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,448.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,795.83
|
| Rate for Payer: Zelis Auto |
$772.40
|
| Rate for Payer: Zelis Worker's Compensation |
$527.16
|
|
|
REPAIR RECTUM-VAGINA FISTULA
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT 57300
|
| Hospital Charge Code |
6157300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.40 |
| 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 |
$688.80
|
| 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 |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: First Health Workers Compensation |
$443.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$918.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| 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 |
$1,044.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| 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 |
$1,090.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| 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 |
$1,067.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$459.20
|
| 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 |
$313.40
|
|
