|
REPAIR/TRANSPOSE NERVE
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT 64856
|
| Hospital Charge Code |
6164856
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$571.93 |
| Max. Negotiated Rate |
$12,161.84 |
| 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 |
$1,257.00
|
| 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 |
$6,080.92
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$1,780.75
|
| Rate for Payer: First Health Commercial |
$1,885.50
|
| Rate for Payer: First Health Workers Compensation |
$808.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,885.50
|
| Rate for Payer: GEHA Commercial |
$1,676.00
|
| Rate for Payer: GEHA Medicare |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,885.50
|
| Rate for Payer: Humana ChoiceCare |
$6,689.01
|
| Rate for Payer: Humana Medicare Advantage |
$6,080.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,215.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,080.92
|
| Rate for Payer: Multiplan All |
$1,906.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,466.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,885.50
|
| 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 |
$6,080.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,990.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,571.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,959.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,080.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,948.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$838.00
|
| Rate for Payer: Zelis Medicare |
$5,168.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,297.10
|
| Rate for Payer: Zelis Worker's Compensation |
$571.93
|
|
|
REPAIR/TRANSPOSE NERVE
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT 64856
|
| Hospital Charge Code |
6164856
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$571.93 |
| Max. Negotiated Rate |
$1,990.25 |
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$1,780.75
|
| Rate for Payer: First Health Commercial |
$1,885.50
|
| Rate for Payer: First Health Workers Compensation |
$808.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,885.50
|
| Rate for Payer: GEHA Commercial |
$1,466.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,885.50
|
| Rate for Payer: Multiplan All |
$1,906.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,466.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,885.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,990.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,571.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,948.35
|
| Rate for Payer: Zelis Auto |
$838.00
|
| Rate for Payer: Zelis Worker's Compensation |
$571.93
|
|
|
REPAIR UMBILICAL LESION
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
CPT 49606
|
| Hospital Charge Code |
6149606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$641.55 |
| Max. Negotiated Rate |
$2,232.50 |
| Rate for Payer: Cash Price |
$1,410.00
|
| Rate for Payer: Cigna Commercial |
$1,997.50
|
| Rate for Payer: First Health Commercial |
$2,115.00
|
| Rate for Payer: First Health Workers Compensation |
$907.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,115.00
|
| Rate for Payer: GEHA Commercial |
$1,645.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,115.00
|
| Rate for Payer: Multiplan All |
$2,138.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,645.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,115.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,232.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,762.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,185.50
|
| Rate for Payer: Zelis Auto |
$940.00
|
| Rate for Payer: Zelis Worker's Compensation |
$641.55
|
|
|
REPAIR UMBILICAL LESION
|
Facility
|
OP
|
$10,481.00
|
|
|
Service Code
|
CPT 49605
|
| Hospital Charge Code |
6149605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,620.25 |
| Max. Negotiated Rate |
$9,956.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,288.60
|
| Rate for Payer: Cash Price |
$6,288.60
|
| Rate for Payer: Cigna Commercial |
$8,908.85
|
| Rate for Payer: First Health Commercial |
$9,432.90
|
| Rate for Payer: First Health Workers Compensation |
$4,046.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,432.90
|
| Rate for Payer: GEHA Commercial |
$8,384.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,432.90
|
| Rate for Payer: Humana ChoiceCare |
$2,725.06
|
| Rate for Payer: Multiplan All |
$9,537.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,288.60
|
| Rate for Payer: OMNI Networks Commercial |
$7,336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9,432.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,956.95
|
| Rate for Payer: Three Rivers Provider Network All |
$7,860.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,223.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,620.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,747.33
|
| Rate for Payer: Zelis Auto |
$4,192.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,240.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.31
|
|
|
REPAIR UMBILICAL LESION
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
CPT 49600
|
| Hospital Charge Code |
6149600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.49 |
| Max. Negotiated Rate |
$1,393.65 |
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,026.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,393.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,364.31
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
REPAIR UMBILICAL LESION
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
CPT 49600
|
| Hospital Charge Code |
6149600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.49 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$880.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,173.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,393.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,364.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
REPAIR UMBILICAL LESION
|
Facility
|
IP
|
$10,481.00
|
|
|
Service Code
|
CPT 49605
|
| Hospital Charge Code |
6149605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,861.31 |
| Max. Negotiated Rate |
$9,956.95 |
| Rate for Payer: Cash Price |
$6,288.60
|
| Rate for Payer: Cigna Commercial |
$8,908.85
|
| Rate for Payer: First Health Commercial |
$9,432.90
|
| Rate for Payer: First Health Workers Compensation |
$4,046.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,432.90
|
| Rate for Payer: GEHA Commercial |
$7,336.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,432.90
|
| Rate for Payer: Multiplan All |
$9,537.71
|
| Rate for Payer: OMNI Networks Commercial |
$7,336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9,432.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,956.95
|
| Rate for Payer: Three Rivers Provider Network All |
$7,860.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,747.33
|
| Rate for Payer: Zelis Auto |
$4,192.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.31
|
|
|
REPAIR UMBILICAL LESION
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
CPT 49606
|
| Hospital Charge Code |
6149606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$2,232.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,410.00
|
| Rate for Payer: Cash Price |
$1,410.00
|
| Rate for Payer: Cigna Commercial |
$1,997.50
|
| Rate for Payer: First Health Commercial |
$2,115.00
|
| Rate for Payer: First Health Workers Compensation |
$907.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,115.00
|
| Rate for Payer: GEHA Commercial |
$1,880.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,115.00
|
| Rate for Payer: Humana ChoiceCare |
$611.00
|
| Rate for Payer: Multiplan All |
$2,138.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,410.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,645.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,115.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,232.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,762.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,068.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$587.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,185.50
|
| Rate for Payer: Zelis Auto |
$940.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,175.00
|
| Rate for Payer: Zelis Worker's Compensation |
$641.55
|
|
|
REPAIR URETHROVAGINAL LESION
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 57311
|
| Hospital Charge Code |
6157311
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna Commercial |
$918.00
|
| Rate for Payer: First Health Commercial |
$972.00
|
| Rate for Payer: First Health Workers Compensation |
$416.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$972.00
|
| Rate for Payer: GEHA Commercial |
$864.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$972.00
|
| Rate for Payer: Humana ChoiceCare |
$280.80
|
| Rate for Payer: Multiplan All |
$982.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.00
|
| Rate for Payer: OMNI Networks Commercial |
$756.00
|
| Rate for Payer: One Health Plan PPO/POS |
$972.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,026.00
|
| Rate for Payer: Three Rivers Provider Network All |
$810.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$950.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,004.40
|
| Rate for Payer: Zelis Auto |
$432.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$540.00
|
| Rate for Payer: Zelis Worker's Compensation |
$294.84
|
|
|
REPAIR URETHROVAGINAL LESION
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 57311
|
| Hospital Charge Code |
6157311
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.84 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna Commercial |
$918.00
|
| Rate for Payer: First Health Commercial |
$972.00
|
| Rate for Payer: First Health Workers Compensation |
$416.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$972.00
|
| Rate for Payer: GEHA Commercial |
$756.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$972.00
|
| Rate for Payer: Multiplan All |
$982.80
|
| Rate for Payer: OMNI Networks Commercial |
$756.00
|
| Rate for Payer: One Health Plan PPO/POS |
$972.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,026.00
|
| Rate for Payer: Three Rivers Provider Network All |
$810.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,004.40
|
| Rate for Payer: Zelis Auto |
$432.00
|
| Rate for Payer: Zelis Worker's Compensation |
$294.84
|
|
|
REPAIR URETHROVAGINAL LESION
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 57310
|
| Hospital Charge Code |
6157310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.44 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$364.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$660.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| Rate for Payer: Multiplan All |
$858.13
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$895.85
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.99
|
| Rate for Payer: Zelis Auto |
$377.20
|
| Rate for Payer: Zelis Worker's Compensation |
$257.44
|
|
|
REPAIR URETHROVAGINAL LESION
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 57310
|
| Hospital Charge Code |
6157310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.44 |
| 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 |
$565.80
|
| 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 |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$364.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$754.40
|
| Rate for Payer: GEHA Medicare |
$7,021.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| 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 |
$858.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,936.84
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| 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 |
$895.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,043.34
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| 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 |
$876.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,021.67
|
| Rate for Payer: Zelis Auto |
$377.20
|
| 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 |
$257.44
|
|
|
REPAIR URO SPHINCTER
|
Facility
|
OP
|
$1,257.00
|
|
|
Service Code
|
CPT 53449
|
| Hospital Charge Code |
6153449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.16 |
| Max. Negotiated Rate |
$17,561.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$754.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,780.54
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna Commercial |
$1,068.45
|
| Rate for Payer: First Health Commercial |
$1,131.30
|
| Rate for Payer: First Health Workers Compensation |
$485.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,131.30
|
| Rate for Payer: GEHA Commercial |
$1,005.60
|
| Rate for Payer: GEHA Medicare |
$8,780.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,131.30
|
| Rate for Payer: Humana ChoiceCare |
$9,658.59
|
| Rate for Payer: Humana Medicare Advantage |
$8,780.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,751.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,780.54
|
| Rate for Payer: Multiplan All |
$1,143.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,926.92
|
| Rate for Payer: OMNI Networks Commercial |
$879.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,131.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,780.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,194.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,561.08
|
| Rate for Payer: Three Rivers Provider Network All |
$942.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,604.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,780.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,169.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,780.54
|
| Rate for Payer: Zelis Auto |
$502.80
|
| Rate for Payer: Zelis Medicare |
$7,463.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,536.65
|
| Rate for Payer: Zelis Worker's Compensation |
$343.16
|
|
|
REPAIR URO SPHINCTER
|
Facility
|
IP
|
$1,257.00
|
|
|
Service Code
|
CPT 53449
|
| Hospital Charge Code |
6153449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.16 |
| Max. Negotiated Rate |
$1,194.15 |
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna Commercial |
$1,068.45
|
| Rate for Payer: First Health Commercial |
$1,131.30
|
| Rate for Payer: First Health Workers Compensation |
$485.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,131.30
|
| Rate for Payer: GEHA Commercial |
$879.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,131.30
|
| Rate for Payer: Multiplan All |
$1,143.87
|
| Rate for Payer: OMNI Networks Commercial |
$879.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,131.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,194.15
|
| Rate for Payer: Three Rivers Provider Network All |
$942.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,169.01
|
| Rate for Payer: Zelis Auto |
$502.80
|
| Rate for Payer: Zelis Worker's Compensation |
$343.16
|
|
|
REPAIR VAGINA
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT 57335
|
| Hospital Charge Code |
6157335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$632.27 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,389.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna Commercial |
$1,968.60
|
| Rate for Payer: First Health Commercial |
$2,084.40
|
| Rate for Payer: First Health Workers Compensation |
$894.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,084.40
|
| Rate for Payer: GEHA Commercial |
$1,852.80
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,084.40
|
| 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 |
$2,107.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,621.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,084.40
|
| 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 |
$2,200.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,737.00
|
| 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 |
$2,153.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$926.40
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$632.27
|
|
|
REPAIR VAGINA
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT 57335
|
| Hospital Charge Code |
6157335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$632.27 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna Commercial |
$1,968.60
|
| Rate for Payer: First Health Commercial |
$2,084.40
|
| Rate for Payer: First Health Workers Compensation |
$894.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,084.40
|
| Rate for Payer: GEHA Commercial |
$1,621.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,084.40
|
| Rate for Payer: Multiplan All |
$2,107.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,621.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,084.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,200.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,737.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,153.88
|
| Rate for Payer: Zelis Auto |
$926.40
|
| Rate for Payer: Zelis Worker's Compensation |
$632.27
|
|
|
REPAIR VAGINA/PERINEUM
|
Facility
|
OP
|
$929.00
|
|
|
Service Code
|
CPT 57210
|
| Hospital Charge Code |
6157210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.62 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$557.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$789.65
|
| Rate for Payer: First Health Commercial |
$836.10
|
| Rate for Payer: First Health Workers Compensation |
$358.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.10
|
| Rate for Payer: GEHA Commercial |
$743.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.10
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$845.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$650.30
|
| Rate for Payer: One Health Plan PPO/POS |
$836.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$882.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$696.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$371.60
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$253.62
|
|
|
REPAIR VAGINA/PERINEUM
|
Facility
|
IP
|
$929.00
|
|
|
Service Code
|
CPT 57210
|
| Hospital Charge Code |
6157210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.62 |
| Max. Negotiated Rate |
$882.55 |
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$789.65
|
| Rate for Payer: First Health Commercial |
$836.10
|
| Rate for Payer: First Health Workers Compensation |
$358.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.10
|
| Rate for Payer: GEHA Commercial |
$650.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.10
|
| Rate for Payer: Multiplan All |
$845.39
|
| Rate for Payer: OMNI Networks Commercial |
$650.30
|
| Rate for Payer: One Health Plan PPO/POS |
$836.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$882.55
|
| Rate for Payer: Three Rivers Provider Network All |
$696.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.97
|
| Rate for Payer: Zelis Auto |
$371.60
|
| Rate for Payer: Zelis Worker's Compensation |
$253.62
|
|
|
REPAIR WEBBED TOE(S)
|
Facility
|
IP
|
$1,422.33
|
|
|
Service Code
|
CPT 28345
|
| Hospital Charge Code |
6128345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$1,351.21 |
| Rate for Payer: Cash Price |
$853.40
|
| Rate for Payer: Cigna Commercial |
$1,208.98
|
| Rate for Payer: First Health Commercial |
$1,280.10
|
| Rate for Payer: First Health Workers Compensation |
$549.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,280.10
|
| Rate for Payer: GEHA Commercial |
$995.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,280.10
|
| Rate for Payer: Multiplan All |
$1,294.32
|
| Rate for Payer: OMNI Networks Commercial |
$995.63
|
| Rate for Payer: One Health Plan PPO/POS |
$1,280.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,351.21
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.77
|
| Rate for Payer: Zelis Auto |
$568.93
|
| Rate for Payer: Zelis Worker's Compensation |
$388.30
|
|
|
REPAIR WEBBED TOE(S)
|
Facility
|
OP
|
$1,422.33
|
|
|
Service Code
|
CPT 28345
|
| Hospital Charge Code |
6128345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 Community HMO |
$853.40
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$853.40
|
| Rate for Payer: Cash Price |
$853.40
|
| Rate for Payer: Cigna Commercial |
$1,208.98
|
| Rate for Payer: First Health Commercial |
$1,280.10
|
| Rate for Payer: First Health Workers Compensation |
$549.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,280.10
|
| Rate for Payer: GEHA Commercial |
$1,137.86
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,280.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,294.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$995.63
|
| Rate for Payer: One Health Plan PPO/POS |
$1,280.10
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,351.21
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$568.93
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$388.30
|
|
|
REPAIR WINDPIPE OPENING
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 31614
|
| Hospital Charge Code |
6131614
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$1,449.70 |
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cigna Commercial |
$1,297.10
|
| Rate for Payer: First Health Commercial |
$1,373.40
|
| Rate for Payer: First Health Workers Compensation |
$589.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,373.40
|
| Rate for Payer: GEHA Commercial |
$1,068.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,373.40
|
| Rate for Payer: Multiplan All |
$1,388.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,373.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,449.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,144.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,419.18
|
| Rate for Payer: Zelis Auto |
$610.40
|
| Rate for Payer: Zelis Worker's Compensation |
$416.60
|
|
|
REPAIR WINDPIPE OPENING
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
6131613
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.07 |
| Max. Negotiated Rate |
$870.20 |
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$778.60
|
| Rate for Payer: First Health Commercial |
$824.40
|
| Rate for Payer: First Health Workers Compensation |
$353.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$824.40
|
| Rate for Payer: GEHA Commercial |
$641.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$824.40
|
| Rate for Payer: Multiplan All |
$833.56
|
| Rate for Payer: OMNI Networks Commercial |
$641.20
|
| Rate for Payer: One Health Plan PPO/POS |
$824.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$870.20
|
| Rate for Payer: Three Rivers Provider Network All |
$687.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$851.88
|
| Rate for Payer: Zelis Auto |
$366.40
|
| Rate for Payer: Zelis Worker's Compensation |
$250.07
|
|
|
REPAIR WINDPIPE OPENING
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
CPT 31614
|
| Hospital Charge Code |
6131614
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.60 |
| 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 |
$915.60
|
| 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 |
$915.60
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cigna Commercial |
$1,297.10
|
| Rate for Payer: First Health Commercial |
$1,373.40
|
| Rate for Payer: First Health Workers Compensation |
$589.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,373.40
|
| Rate for Payer: GEHA Commercial |
$1,220.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,373.40
|
| 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 |
$1,388.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,373.40
|
| 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 |
$1,449.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,144.50
|
| 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 |
$1,419.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$610.40
|
| 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 |
$416.60
|
|
|
REPAIR WINDPIPE OPENING
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
6131613
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.07 |
| Max. Negotiated Rate |
$6,158.84 |
| 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 |
$549.60
|
| 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 |
$3,079.42
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$778.60
|
| Rate for Payer: First Health Commercial |
$824.40
|
| Rate for Payer: First Health Workers Compensation |
$353.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$824.40
|
| Rate for Payer: GEHA Commercial |
$732.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$824.40
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$833.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$641.20
|
| Rate for Payer: One Health Plan PPO/POS |
$824.40
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$870.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$687.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$851.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$366.40
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$250.07
|
|
|
REPAIR WRIST JOINTS
|
Facility
|
IP
|
$1,686.00
|
|
|
Service Code
|
CPT 25447
|
| Hospital Charge Code |
6125447
|
|
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
|
|
