|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$1,945.00
|
|
|
Service Code
|
CPT 23450
|
| Hospital Charge Code |
6123450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$530.99 |
| Max. Negotiated Rate |
$1,847.75 |
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,653.25
|
| Rate for Payer: First Health Commercial |
$1,750.50
|
| Rate for Payer: First Health Workers Compensation |
$750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,750.50
|
| Rate for Payer: GEHA Commercial |
$1,361.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,750.50
|
| Rate for Payer: Multiplan All |
$1,769.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,361.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,750.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,847.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,458.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,808.85
|
| Rate for Payer: Zelis Auto |
$778.00
|
| Rate for Payer: Zelis Worker's Compensation |
$530.99
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
CPT 23460
|
| Hospital Charge Code |
6123460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$613.70 |
| 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 |
$1,348.80
|
| 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 |
$1,348.80
|
| 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 |
$1,798.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,023.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,045.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,573.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,023.20
|
| 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 |
$2,135.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,686.00
|
| 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 |
$2,090.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$899.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$613.70
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$1,945.00
|
|
|
Service Code
|
CPT 23450
|
| Hospital Charge Code |
6123450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$530.99 |
| 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 |
$1,167.00
|
| 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 |
$1,167.00
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,653.25
|
| Rate for Payer: First Health Commercial |
$1,750.50
|
| Rate for Payer: First Health Workers Compensation |
$750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,750.50
|
| Rate for Payer: GEHA Commercial |
$1,556.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,750.50
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,769.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,361.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,750.50
|
| 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 |
$1,847.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,458.75
|
| 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 |
$1,808.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$778.00
|
| 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 |
$530.99
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$2,058.00
|
|
|
Service Code
|
CPT 23455
|
| Hospital Charge Code |
6123455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.83 |
| 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 |
$1,234.80
|
| 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 |
$1,234.80
|
| 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 |
$1,646.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,852.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,872.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,440.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,852.20
|
| 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 |
$1,955.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,543.50
|
| 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 |
$1,913.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$823.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$561.83
|
|
|
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
|
|
|
REPAIR SPIGELIAN HERNIA
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 49590
|
| Hospital Charge Code |
6149590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$462.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Humana ChoiceCare |
$311.22
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.20
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,053.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$598.50
|
| Rate for Payer: Zelis Worker's Compensation |
$326.78
|
|
|
REPAIR SPIGELIAN HERNIA
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 49590
|
| Hospital Charge Code |
6149590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$326.78 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$462.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$837.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Worker's Compensation |
$326.78
|
|
|
REPAIR STOMACH-BOWEL FISTULA
|
Facility
|
IP
|
$3,371.00
|
|
|
Service Code
|
CPT 43880
|
| Hospital Charge Code |
6143880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$920.28 |
| Max. Negotiated Rate |
$3,202.45 |
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$2,865.35
|
| Rate for Payer: First Health Commercial |
$3,033.90
|
| Rate for Payer: First Health Workers Compensation |
$1,301.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.90
|
| Rate for Payer: GEHA Commercial |
$2,359.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.90
|
| Rate for Payer: Multiplan All |
$3,067.61
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,202.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,528.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,135.03
|
| Rate for Payer: Zelis Auto |
$1,348.40
|
| Rate for Payer: Zelis Worker's Compensation |
$920.28
|
|
|
REPAIR STOMACH-BOWEL FISTULA
|
Facility
|
OP
|
$3,371.00
|
|
|
Service Code
|
CPT 43880
|
| Hospital Charge Code |
6143880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$842.75 |
| Max. Negotiated Rate |
$3,202.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,022.60
|
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$2,865.35
|
| Rate for Payer: First Health Commercial |
$3,033.90
|
| Rate for Payer: First Health Workers Compensation |
$1,301.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.90
|
| Rate for Payer: GEHA Commercial |
$2,696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.90
|
| Rate for Payer: Humana ChoiceCare |
$876.46
|
| Rate for Payer: Multiplan All |
$3,067.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,022.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,202.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,966.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$842.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,135.03
|
| Rate for Payer: Zelis Auto |
$1,348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,685.50
|
| Rate for Payer: Zelis Worker's Compensation |
$920.28
|
|
|
REPAIR STOMACH OPENING
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 43870
|
| Hospital Charge Code |
6143870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$7,225.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,612.55
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cigna Commercial |
$1,268.20
|
| Rate for Payer: First Health Commercial |
$1,342.80
|
| Rate for Payer: First Health Workers Compensation |
$576.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,342.80
|
| Rate for Payer: GEHA Commercial |
$1,193.60
|
| Rate for Payer: GEHA Medicare |
$3,612.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,342.80
|
| Rate for Payer: Humana ChoiceCare |
$3,973.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,612.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,069.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,612.55
|
| Rate for Payer: Multiplan All |
$1,357.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,141.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,044.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,342.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,612.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,417.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,225.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,119.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,540.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,612.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,387.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,612.55
|
| Rate for Payer: Zelis Auto |
$596.80
|
| Rate for Payer: Zelis Medicare |
$3,070.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,335.06
|
| Rate for Payer: Zelis Worker's Compensation |
$407.32
|
|
|
REPAIR STOMACH OPENING
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 43870
|
| Hospital Charge Code |
6143870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$1,417.40 |
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cigna Commercial |
$1,268.20
|
| Rate for Payer: First Health Commercial |
$1,342.80
|
| Rate for Payer: First Health Workers Compensation |
$576.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,342.80
|
| Rate for Payer: GEHA Commercial |
$1,044.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,342.80
|
| Rate for Payer: Multiplan All |
$1,357.72
|
| Rate for Payer: OMNI Networks Commercial |
$1,044.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,342.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,417.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,119.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,387.56
|
| Rate for Payer: Zelis Auto |
$596.80
|
| Rate for Payer: Zelis Worker's Compensation |
$407.32
|
|
|
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY (EXCLUDES ROTATOR CUFF)
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 24341
|
|
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 TESTIS INJURY
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT 54670
|
| Hospital Charge Code |
6154670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.04 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$496.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$319.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$662.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$226.04
|
|
|
REPAIR TESTIS INJURY
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 54670
|
| Hospital Charge Code |
6154670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.04 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$319.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$579.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Worker's Compensation |
$226.04
|
|
|
REPAIR THROAT ESOPHAGUS
|
Facility
|
IP
|
$2,018.00
|
|
|
Service Code
|
CPT 42953
|
| Hospital Charge Code |
6142953
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$550.91 |
| Max. Negotiated Rate |
$1,917.10 |
| Rate for Payer: Cash Price |
$1,210.80
|
| Rate for Payer: Cigna Commercial |
$1,715.30
|
| Rate for Payer: First Health Commercial |
$1,816.20
|
| Rate for Payer: First Health Workers Compensation |
$779.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,816.20
|
| Rate for Payer: GEHA Commercial |
$1,412.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,816.20
|
| Rate for Payer: Multiplan All |
$1,836.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,412.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,816.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,917.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,513.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,876.74
|
| Rate for Payer: Zelis Auto |
$807.20
|
| Rate for Payer: Zelis Worker's Compensation |
$550.91
|
|
|
REPAIR THROAT ESOPHAGUS
|
Facility
|
OP
|
$2,018.00
|
|
|
Service Code
|
CPT 42953
|
| Hospital Charge Code |
6142953
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$504.50 |
| Max. Negotiated Rate |
$1,917.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,210.80
|
| Rate for Payer: Cash Price |
$1,210.80
|
| Rate for Payer: Cigna Commercial |
$1,715.30
|
| Rate for Payer: First Health Commercial |
$1,816.20
|
| Rate for Payer: First Health Workers Compensation |
$779.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,816.20
|
| Rate for Payer: GEHA Commercial |
$1,614.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,816.20
|
| Rate for Payer: Humana ChoiceCare |
$524.68
|
| Rate for Payer: Multiplan All |
$1,836.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,210.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,412.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,816.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,917.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,513.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,775.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$504.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,876.74
|
| Rate for Payer: Zelis Auto |
$807.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,009.00
|
| Rate for Payer: Zelis Worker's Compensation |
$550.91
|
|
|
REPAIR THROAT WOUND
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 42900
|
| Hospital Charge Code |
6142900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$613.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
REPAIR THROAT WOUND
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 42900
|
| Hospital Charge Code |
6142900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
REPAIR TOE DISLOCATION
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 28645
|
| Hospital Charge Code |
6128645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.82 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: First Health Commercial |
$892.80
|
| Rate for Payer: First Health Workers Compensation |
$383.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$892.80
|
| Rate for Payer: GEHA Commercial |
$694.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$892.80
|
| Rate for Payer: Multiplan All |
$902.72
|
| Rate for Payer: OMNI Networks Commercial |
$694.40
|
| Rate for Payer: One Health Plan PPO/POS |
$892.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$942.40
|
| Rate for Payer: Three Rivers Provider Network All |
$744.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$922.56
|
| Rate for Payer: Zelis Auto |
$396.80
|
| Rate for Payer: Zelis Worker's Compensation |
$270.82
|
|
|
REPAIR TOE DISLOCATION
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 28645
|
| Hospital Charge Code |
6128645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.82 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$595.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: First Health Commercial |
$892.80
|
| Rate for Payer: First Health Workers Compensation |
$383.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$892.80
|
| Rate for Payer: GEHA Commercial |
$793.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$892.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$902.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$694.40
|
| Rate for Payer: One Health Plan PPO/POS |
$892.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$942.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$744.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$922.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$396.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$270.82
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
6141252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$382.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
6141252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$770.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
6141251
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$395.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: Zelis Auto |
$226.00
|
| Rate for Payer: Zelis Worker's Compensation |
$154.25
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
6141251
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$452.00
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$226.00
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$154.25
|
|
