|
REPAIR RENAL-ABDOMEN FISTULA
|
Facility
|
IP
|
$3,073.00
|
|
|
Service Code
|
CPT 50526
|
| Hospital Charge Code |
6150526
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$838.93 |
| Max. Negotiated Rate |
$2,919.35 |
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$2,612.05
|
| Rate for Payer: First Health Commercial |
$2,765.70
|
| Rate for Payer: First Health Workers Compensation |
$1,186.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,765.70
|
| Rate for Payer: GEHA Commercial |
$2,151.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,765.70
|
| Rate for Payer: Multiplan All |
$2,796.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,151.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,765.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,919.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,304.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,857.89
|
| Rate for Payer: Zelis Auto |
$1,229.20
|
| Rate for Payer: Zelis Worker's Compensation |
$838.93
|
|
|
REPAIR RENAL-ABDOMEN FISTULA
|
Facility
|
IP
|
$2,976.00
|
|
|
Service Code
|
CPT 50525
|
| Hospital Charge Code |
6150525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$812.45 |
| Max. Negotiated Rate |
$2,827.20 |
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cigna Commercial |
$2,529.60
|
| Rate for Payer: First Health Commercial |
$2,678.40
|
| Rate for Payer: First Health Workers Compensation |
$1,149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,678.40
|
| Rate for Payer: GEHA Commercial |
$2,083.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,678.40
|
| Rate for Payer: Multiplan All |
$2,708.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,083.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,678.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,827.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,232.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,767.68
|
| Rate for Payer: Zelis Auto |
$1,190.40
|
| Rate for Payer: Zelis Worker's Compensation |
$812.45
|
|
|
REPAIR RENAL-ABDOMEN FISTULA
|
Facility
|
OP
|
$3,073.00
|
|
|
Service Code
|
CPT 50526
|
| Hospital Charge Code |
6150526
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$768.25 |
| Max. Negotiated Rate |
$2,919.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$2,612.05
|
| Rate for Payer: First Health Commercial |
$2,765.70
|
| Rate for Payer: First Health Workers Compensation |
$1,186.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,765.70
|
| Rate for Payer: GEHA Commercial |
$2,458.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,765.70
|
| Rate for Payer: Humana ChoiceCare |
$798.98
|
| Rate for Payer: Multiplan All |
$2,796.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,843.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,151.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,765.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,919.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,304.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,704.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$768.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,857.89
|
| Rate for Payer: Zelis Auto |
$1,229.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,536.50
|
| Rate for Payer: Zelis Worker's Compensation |
$838.93
|
|
|
REPAIR RENAL-ABDOMEN FISTULA
|
Facility
|
OP
|
$2,976.00
|
|
|
Service Code
|
CPT 50525
|
| Hospital Charge Code |
6150525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$744.00 |
| Max. Negotiated Rate |
$2,827.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cigna Commercial |
$2,529.60
|
| Rate for Payer: First Health Commercial |
$2,678.40
|
| Rate for Payer: First Health Workers Compensation |
$1,149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,678.40
|
| Rate for Payer: GEHA Commercial |
$2,380.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,678.40
|
| Rate for Payer: Humana ChoiceCare |
$773.76
|
| Rate for Payer: Multiplan All |
$2,708.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,785.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,083.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,678.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,827.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,232.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,618.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,767.68
|
| Rate for Payer: Zelis Auto |
$1,190.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,488.00
|
| Rate for Payer: Zelis Worker's Compensation |
$812.45
|
|
|
REPAIR/REVISE WRIST JOINT
|
Facility
|
IP
|
$2,006.00
|
|
|
Service Code
|
CPT 25320
|
| Hospital Charge Code |
6125320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$547.64 |
| Max. Negotiated Rate |
$1,905.70 |
| Rate for Payer: Cash Price |
$1,203.60
|
| Rate for Payer: Cigna Commercial |
$1,705.10
|
| Rate for Payer: First Health Commercial |
$1,805.40
|
| Rate for Payer: First Health Workers Compensation |
$774.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,805.40
|
| Rate for Payer: GEHA Commercial |
$1,404.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,805.40
|
| Rate for Payer: Multiplan All |
$1,825.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,404.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,805.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,905.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,504.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,865.58
|
| Rate for Payer: Zelis Auto |
$802.40
|
| Rate for Payer: Zelis Worker's Compensation |
$547.64
|
|
|
REPAIR/REVISE WRIST JOINT
|
Facility
|
OP
|
$2,006.00
|
|
|
Service Code
|
CPT 25320
|
| Hospital Charge Code |
6125320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$547.64 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,203.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,203.60
|
| Rate for Payer: Cash Price |
$1,203.60
|
| Rate for Payer: Cigna Commercial |
$1,705.10
|
| Rate for Payer: First Health Commercial |
$1,805.40
|
| Rate for Payer: First Health Workers Compensation |
$774.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,805.40
|
| Rate for Payer: GEHA Commercial |
$1,604.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,805.40
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,825.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,404.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,805.40
|
| 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 |
$1,905.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,504.50
|
| 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 |
$1,865.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$802.40
|
| 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 |
$547.64
|
|
|
REPAIR ROTATOR CUFF ACUTE
|
Facility
|
IP
|
$1,686.00
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
6123410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$460.28 |
| Max. Negotiated Rate |
$1,601.70 |
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$1,433.10
|
| Rate for Payer: First Health Commercial |
$1,517.40
|
| Rate for Payer: First Health Workers Compensation |
$650.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,517.40
|
| Rate for Payer: GEHA Commercial |
$1,180.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,517.40
|
| Rate for Payer: Multiplan All |
$1,534.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,180.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,517.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,601.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,264.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.98
|
| Rate for Payer: Zelis Auto |
$674.40
|
| Rate for Payer: Zelis Worker's Compensation |
$460.28
|
|
|
REPAIR ROTATOR CUFF ACUTE
|
Facility
|
OP
|
$1,686.00
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
6123410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$460.28 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,011.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$1,433.10
|
| Rate for Payer: First Health Commercial |
$1,517.40
|
| Rate for Payer: First Health Workers Compensation |
$650.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,517.40
|
| Rate for Payer: GEHA Commercial |
$1,348.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,517.40
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,534.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,180.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,517.40
|
| 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 |
$1,601.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,264.50
|
| 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 |
$1,567.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$674.40
|
| 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 |
$460.28
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
6123412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.00
|
| 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 |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,400.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| 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 |
$1,592.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| 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 |
$1,662.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| 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 |
$1,627.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$700.00
|
| 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 |
$477.75
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
6123412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,225.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 42505
|
| Hospital Charge Code |
6142505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$891.10 |
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$797.30
|
| Rate for Payer: First Health Commercial |
$844.20
|
| Rate for Payer: First Health Workers Compensation |
$362.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$844.20
|
| Rate for Payer: GEHA Commercial |
$656.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$844.20
|
| Rate for Payer: Multiplan All |
$853.58
|
| Rate for Payer: OMNI Networks Commercial |
$656.60
|
| Rate for Payer: One Health Plan PPO/POS |
$844.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$891.10
|
| Rate for Payer: Three Rivers Provider Network All |
$703.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$872.34
|
| Rate for Payer: Zelis Auto |
$375.20
|
| Rate for Payer: Zelis Worker's Compensation |
$256.07
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 42500
|
| Hospital Charge Code |
6142500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.79 |
| 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 |
$529.20
|
| 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 |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cigna Commercial |
$749.70
|
| Rate for Payer: First Health Commercial |
$793.80
|
| Rate for Payer: First Health Workers Compensation |
$340.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$793.80
|
| Rate for Payer: GEHA Commercial |
$705.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$793.80
|
| 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 |
$802.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$617.40
|
| Rate for Payer: One Health Plan PPO/POS |
$793.80
|
| 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 |
$837.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$661.50
|
| 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 |
$820.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$352.80
|
| 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 |
$240.79
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 42505
|
| Hospital Charge Code |
6142505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$562.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$797.30
|
| Rate for Payer: First Health Commercial |
$844.20
|
| Rate for Payer: First Health Workers Compensation |
$362.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$844.20
|
| Rate for Payer: GEHA Commercial |
$750.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$844.20
|
| 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 |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$853.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$656.60
|
| Rate for Payer: One Health Plan PPO/POS |
$844.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$891.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$703.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$872.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$375.20
|
| 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 |
$256.07
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 42500
|
| Hospital Charge Code |
6142500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$837.90 |
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cigna Commercial |
$749.70
|
| Rate for Payer: First Health Commercial |
$793.80
|
| Rate for Payer: First Health Workers Compensation |
$340.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$793.80
|
| Rate for Payer: GEHA Commercial |
$617.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$793.80
|
| Rate for Payer: Multiplan All |
$802.62
|
| Rate for Payer: OMNI Networks Commercial |
$617.40
|
| Rate for Payer: One Health Plan PPO/POS |
$793.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$837.90
|
| Rate for Payer: Three Rivers Provider Network All |
$661.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$820.26
|
| Rate for Payer: Zelis Auto |
$352.80
|
| Rate for Payer: Zelis Worker's Compensation |
$240.79
|
|
|
REPAIR SCIATIC NERVE
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
CPT 64858
|
| Hospital Charge Code |
6164858
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$639.37 |
| Max. Negotiated Rate |
$2,224.90 |
| Rate for Payer: Cash Price |
$1,405.20
|
| Rate for Payer: Cigna Commercial |
$1,990.70
|
| Rate for Payer: First Health Commercial |
$2,107.80
|
| Rate for Payer: First Health Workers Compensation |
$904.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,107.80
|
| Rate for Payer: GEHA Commercial |
$1,639.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,107.80
|
| Rate for Payer: Multiplan All |
$2,131.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,639.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,107.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,224.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,756.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,178.06
|
| Rate for Payer: Zelis Auto |
$936.80
|
| Rate for Payer: Zelis Worker's Compensation |
$639.37
|
|
|
REPAIR SCIATIC NERVE
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
CPT 64858
|
| Hospital Charge Code |
6164858
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$639.37 |
| Max. Negotiated Rate |
$3,769.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,405.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,986.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$1,405.20
|
| Rate for Payer: Cash Price |
$1,405.20
|
| Rate for Payer: Cigna Commercial |
$1,990.70
|
| Rate for Payer: First Health Commercial |
$2,107.80
|
| Rate for Payer: First Health Workers Compensation |
$904.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,107.80
|
| Rate for Payer: GEHA Commercial |
$1,873.60
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,107.80
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$2,131.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,639.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,107.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,224.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,756.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,178.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$936.80
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$639.37
|
|
|
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27654
|
|
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, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,544.86 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: 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 |
$2,596.69
|
| 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 |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: 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 SHOULDER CAPSULE
|
Facility
|
IP
|
$2,058.00
|
|
|
Service Code
|
CPT 23455
|
| Hospital Charge Code |
6123455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.83 |
| Max. Negotiated Rate |
$1,955.10 |
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$1,749.30
|
| Rate for Payer: First Health Commercial |
$1,852.20
|
| Rate for Payer: First Health Workers Compensation |
$794.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,852.20
|
| Rate for Payer: GEHA Commercial |
$1,440.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,852.20
|
| Rate for Payer: Multiplan All |
$1,872.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,440.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,852.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,955.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,543.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,913.94
|
| Rate for Payer: Zelis Auto |
$823.20
|
| Rate for Payer: Zelis Worker's Compensation |
$561.83
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$2,289.00
|
|
|
Service Code
|
CPT 23465
|
| Hospital Charge Code |
6123465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.90 |
| 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 |
$1,373.40
|
| 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 |
$1,373.40
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cigna Commercial |
$1,945.65
|
| Rate for Payer: First Health Commercial |
$2,060.10
|
| Rate for Payer: First Health Workers Compensation |
$883.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,060.10
|
| Rate for Payer: GEHA Commercial |
$1,831.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,060.10
|
| 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 |
$2,082.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,602.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,060.10
|
| 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 |
$2,174.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,716.75
|
| 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 |
$2,128.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$915.60
|
| 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 |
$624.90
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
CPT 23460
|
| Hospital Charge Code |
6123460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$613.70 |
| Max. Negotiated Rate |
$2,135.60 |
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cigna Commercial |
$1,910.80
|
| Rate for Payer: First Health Commercial |
$2,023.20
|
| Rate for Payer: First Health Workers Compensation |
$867.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,023.20
|
| Rate for Payer: GEHA Commercial |
$1,573.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,023.20
|
| Rate for Payer: Multiplan All |
$2,045.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,573.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,023.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,135.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,686.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,090.64
|
| Rate for Payer: Zelis Auto |
$899.20
|
| Rate for Payer: Zelis Worker's Compensation |
$613.70
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$2,296.00
|
|
|
Service Code
|
CPT 23466
|
| Hospital Charge Code |
6123466
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$2,181.20 |
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$1,951.60
|
| Rate for Payer: First Health Commercial |
$2,066.40
|
| Rate for Payer: First Health Workers Compensation |
$886.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,066.40
|
| Rate for Payer: GEHA Commercial |
$1,607.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,066.40
|
| Rate for Payer: Multiplan All |
$2,089.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,066.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,181.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,135.28
|
| Rate for Payer: Zelis Auto |
$918.40
|
| Rate for Payer: Zelis Worker's Compensation |
$626.81
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$2,296.00
|
|
|
Service Code
|
CPT 23466
|
| Hospital Charge Code |
6123466
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,377.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$1,951.60
|
| Rate for Payer: First Health Commercial |
$2,066.40
|
| Rate for Payer: First Health Workers Compensation |
$886.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,066.40
|
| Rate for Payer: GEHA Commercial |
$1,836.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,066.40
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,089.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,066.40
|
| 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 |
$2,181.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,135.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$918.40
|
| 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 |
$626.81
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 23462
|
| Hospital Charge Code |
6123462
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.50 |
| Max. Negotiated Rate |
$2,075.75 |
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: First Health Workers Compensation |
$843.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,966.50
|
| Rate for Payer: GEHA Commercial |
$1,529.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,966.50
|
| Rate for Payer: Multiplan All |
$1,988.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,529.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,966.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,075.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,638.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,032.05
|
| Rate for Payer: Zelis Auto |
$874.00
|
| Rate for Payer: Zelis Worker's Compensation |
$596.50
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$2,289.00
|
|
|
Service Code
|
CPT 23465
|
| Hospital Charge Code |
6123465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.90 |
| Max. Negotiated Rate |
$2,174.55 |
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cigna Commercial |
$1,945.65
|
| Rate for Payer: First Health Commercial |
$2,060.10
|
| Rate for Payer: First Health Workers Compensation |
$883.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,060.10
|
| Rate for Payer: GEHA Commercial |
$1,602.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,060.10
|
| Rate for Payer: Multiplan All |
$2,082.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,602.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,060.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,174.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,716.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,128.77
|
| Rate for Payer: Zelis Auto |
$915.60
|
| Rate for Payer: Zelis Worker's Compensation |
$624.90
|
|
