|
REPLACE VAD INTRA W/BP
|
Facility
|
IP
|
$4,965.00
|
|
|
Service Code
|
CPT 33983
|
| Hospital Charge Code |
6133983
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,355.44 |
| Max. Negotiated Rate |
$4,716.75 |
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$4,220.25
|
| Rate for Payer: First Health Commercial |
$4,468.50
|
| Rate for Payer: First Health Workers Compensation |
$1,916.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,468.50
|
| Rate for Payer: GEHA Commercial |
$3,475.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,468.50
|
| Rate for Payer: Multiplan All |
$4,518.15
|
| Rate for Payer: OMNI Networks Commercial |
$3,475.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,468.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,716.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,723.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,617.45
|
| Rate for Payer: Zelis Auto |
$1,986.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,355.44
|
|
|
REPLACE VAD INTRA W/O BP
|
Facility
|
IP
|
$4,239.00
|
|
|
Service Code
|
CPT 33982
|
| Hospital Charge Code |
6133982
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,157.25 |
| Max. Negotiated Rate |
$4,027.05 |
| Rate for Payer: Cash Price |
$2,543.40
|
| Rate for Payer: Cigna Commercial |
$3,603.15
|
| Rate for Payer: First Health Commercial |
$3,815.10
|
| Rate for Payer: First Health Workers Compensation |
$1,636.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,815.10
|
| Rate for Payer: GEHA Commercial |
$2,967.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,815.10
|
| Rate for Payer: Multiplan All |
$3,857.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,967.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,815.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,027.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,942.27
|
| Rate for Payer: Zelis Auto |
$1,695.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,157.25
|
|
|
REPLACE VAD INTRA W/O BP
|
Facility
|
OP
|
$4,239.00
|
|
|
Service Code
|
CPT 33982
|
| Hospital Charge Code |
6133982
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,059.75 |
| Max. Negotiated Rate |
$4,027.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,543.40
|
| Rate for Payer: Cash Price |
$2,543.40
|
| Rate for Payer: Cigna Commercial |
$3,603.15
|
| Rate for Payer: First Health Commercial |
$3,815.10
|
| Rate for Payer: First Health Workers Compensation |
$1,636.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,815.10
|
| Rate for Payer: GEHA Commercial |
$3,391.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,815.10
|
| Rate for Payer: Humana ChoiceCare |
$1,102.14
|
| Rate for Payer: Multiplan All |
$3,857.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,543.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,967.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,815.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,027.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,730.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,059.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,942.27
|
| Rate for Payer: Zelis Auto |
$1,695.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,119.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,157.25
|
|
|
REPLACE VAD PUMP EXT
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
CPT 33981
|
| Hospital Charge Code |
6133981
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,076.40
|
| Rate for Payer: Cash Price |
$1,076.40
|
| Rate for Payer: Cigna Commercial |
$1,524.90
|
| Rate for Payer: First Health Commercial |
$1,614.60
|
| Rate for Payer: First Health Workers Compensation |
$692.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,614.60
|
| Rate for Payer: GEHA Commercial |
$1,435.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,614.60
|
| Rate for Payer: Humana ChoiceCare |
$466.44
|
| Rate for Payer: Multiplan All |
$1,632.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,076.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,255.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,614.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,704.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,345.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,578.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$448.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,668.42
|
| Rate for Payer: Zelis Auto |
$717.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$897.00
|
| Rate for Payer: Zelis Worker's Compensation |
$489.76
|
|
|
REPLACE VAD PUMP EXT
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
CPT 33981
|
| Hospital Charge Code |
6133981
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$489.76 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Cash Price |
$1,076.40
|
| Rate for Payer: Cigna Commercial |
$1,524.90
|
| Rate for Payer: First Health Commercial |
$1,614.60
|
| Rate for Payer: First Health Workers Compensation |
$692.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,614.60
|
| Rate for Payer: GEHA Commercial |
$1,255.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,614.60
|
| Rate for Payer: Multiplan All |
$1,632.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,255.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,614.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,704.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,345.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,668.42
|
| Rate for Payer: Zelis Auto |
$717.60
|
| Rate for Payer: Zelis Worker's Compensation |
$489.76
|
|
|
REPLANTATION FOOT COMPLETE
|
Facility
|
OP
|
$5,030.00
|
|
|
Service Code
|
CPT 20838
|
| Hospital Charge Code |
6120838
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,257.50 |
| Max. Negotiated Rate |
$4,778.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,018.00
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$4,275.50
|
| Rate for Payer: First Health Commercial |
$4,527.00
|
| Rate for Payer: First Health Workers Compensation |
$1,942.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,527.00
|
| Rate for Payer: GEHA Commercial |
$4,024.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,527.00
|
| Rate for Payer: Humana ChoiceCare |
$1,307.80
|
| Rate for Payer: Multiplan All |
$4,577.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,018.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,521.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,527.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,778.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,772.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,426.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,677.90
|
| Rate for Payer: Zelis Auto |
$2,012.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,515.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,373.19
|
|
|
REPLANTATION FOOT COMPLETE
|
Facility
|
IP
|
$5,030.00
|
|
|
Service Code
|
CPT 20838
|
| Hospital Charge Code |
6120838
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,373.19 |
| Max. Negotiated Rate |
$4,778.50 |
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$4,275.50
|
| Rate for Payer: First Health Commercial |
$4,527.00
|
| Rate for Payer: First Health Workers Compensation |
$1,942.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,527.00
|
| Rate for Payer: GEHA Commercial |
$3,521.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,527.00
|
| Rate for Payer: Multiplan All |
$4,577.30
|
| Rate for Payer: OMNI Networks Commercial |
$3,521.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,527.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,778.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,772.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,677.90
|
| Rate for Payer: Zelis Auto |
$2,012.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,373.19
|
|
|
REPLANTATION HAND COMPLETE
|
Facility
|
IP
|
$8,323.00
|
|
|
Service Code
|
CPT 20808
|
| Hospital Charge Code |
6120808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,272.18 |
| Max. Negotiated Rate |
$7,906.85 |
| Rate for Payer: Cash Price |
$4,993.80
|
| Rate for Payer: Cigna Commercial |
$7,074.55
|
| Rate for Payer: First Health Commercial |
$7,490.70
|
| Rate for Payer: First Health Workers Compensation |
$3,213.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,490.70
|
| Rate for Payer: GEHA Commercial |
$5,826.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,490.70
|
| Rate for Payer: Multiplan All |
$7,573.93
|
| Rate for Payer: OMNI Networks Commercial |
$5,826.10
|
| Rate for Payer: One Health Plan PPO/POS |
$7,490.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,906.85
|
| Rate for Payer: Three Rivers Provider Network All |
$6,242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,740.39
|
| Rate for Payer: Zelis Auto |
$3,329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,272.18
|
|
|
REPLANTATION HAND COMPLETE
|
Facility
|
OP
|
$8,323.00
|
|
|
Service Code
|
CPT 20808
|
| Hospital Charge Code |
6120808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,080.75 |
| Max. Negotiated Rate |
$7,906.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,993.80
|
| Rate for Payer: Cash Price |
$4,993.80
|
| Rate for Payer: Cigna Commercial |
$7,074.55
|
| Rate for Payer: First Health Commercial |
$7,490.70
|
| Rate for Payer: First Health Workers Compensation |
$3,213.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,490.70
|
| Rate for Payer: GEHA Commercial |
$6,658.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,490.70
|
| Rate for Payer: Humana ChoiceCare |
$2,163.98
|
| Rate for Payer: Multiplan All |
$7,573.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,993.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,826.10
|
| Rate for Payer: One Health Plan PPO/POS |
$7,490.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,906.85
|
| Rate for Payer: Three Rivers Provider Network All |
$6,242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,324.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,080.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,740.39
|
| Rate for Payer: Zelis Auto |
$3,329.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,161.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,272.18
|
|
|
REPL NASAL PILLOW COMB MASK
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT A7029
|
| Hospital Charge Code |
3000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$32.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
REPL NASAL PILLOW COMB MASK
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT A7029
|
| Hospital Charge Code |
3000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$36.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$11.96
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.60
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$40.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
REPL WATER CHAMBER, PAP DEV
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT A7046
|
| Hospital Charge Code |
3000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$31.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$10.14
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.40
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
REPL WATER CHAMBER, PAP DEV
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT A7046
|
| Hospital Charge Code |
3000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$27.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
REPOSITION GASTROSTOMY TUBE
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
6143761
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.91 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$124.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$225.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| Rate for Payer: Multiplan All |
$293.02
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$305.90
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$299.46
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Worker's Compensation |
$87.91
|
|
|
REPOSITION GASTROSTOMY TUBE
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
6143761
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.91 |
| Max. Negotiated Rate |
$884.33 |
| 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 |
$193.20
|
| 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 |
$230.94
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$124.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$293.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| 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 |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$305.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$299.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$87.91
|
|
|
REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
6133993
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$468.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Humana ChoiceCare |
$152.10
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$351.00
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$514.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.50
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
6133993
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.71 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$409.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
REP PERF ANOPER FISTU
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
CPT 46715
|
| Hospital Charge Code |
6146715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$433.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$786.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,045.32
|
| Rate for Payer: Zelis Auto |
$449.60
|
| Rate for Payer: Zelis Worker's Compensation |
$306.85
|
|
|
REP PERF ANOPER FISTU
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
CPT 46715
|
| Hospital Charge Code |
6146715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$433.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$899.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Humana ChoiceCare |
$292.24
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$674.40
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$989.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$281.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,045.32
|
| Rate for Payer: Zelis Auto |
$449.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$562.00
|
| Rate for Payer: Zelis Worker's Compensation |
$306.85
|
|
|
REP PERF ANOPER/VESTIB FISTU
|
Facility
|
OP
|
$2,283.00
|
|
|
Service Code
|
CPT 46716
|
| Hospital Charge Code |
6146716
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$570.75 |
| Max. Negotiated Rate |
$2,168.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,369.80
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: First Health Workers Compensation |
$881.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,826.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| Rate for Payer: Humana ChoiceCare |
$593.58
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,369.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,009.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: Zelis Auto |
$913.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,141.50
|
| Rate for Payer: Zelis Worker's Compensation |
$623.26
|
|
|
REP PERF ANOPER/VESTIB FISTU
|
Facility
|
IP
|
$2,283.00
|
|
|
Service Code
|
CPT 46716
|
| Hospital Charge Code |
6146716
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$623.26 |
| Max. Negotiated Rate |
$2,168.85 |
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: First Health Workers Compensation |
$881.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,598.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: Zelis Auto |
$913.20
|
| Rate for Payer: Zelis Worker's Compensation |
$623.26
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Facility
|
OP
|
$1,438.00
|
|
|
Service Code
|
CPT 24343
|
| Hospital Charge Code |
6124343
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$392.57 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 Community HMO |
$862.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$1,222.30
|
| Rate for Payer: First Health Commercial |
$1,294.20
|
| Rate for Payer: First Health Workers Compensation |
$555.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,294.20
|
| Rate for Payer: GEHA Commercial |
$1,150.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,294.20
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,308.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,006.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,294.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,366.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,078.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,337.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$575.20
|
| 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 |
$392.57
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Facility
|
IP
|
$1,438.00
|
|
|
Service Code
|
CPT 24343
|
| Hospital Charge Code |
6124343
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$392.57 |
| Max. Negotiated Rate |
$1,366.10 |
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$1,222.30
|
| Rate for Payer: First Health Commercial |
$1,294.20
|
| Rate for Payer: First Health Workers Compensation |
$555.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,294.20
|
| Rate for Payer: GEHA Commercial |
$1,006.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,294.20
|
| Rate for Payer: Multiplan All |
$1,308.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,006.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,294.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,366.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,078.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,337.34
|
| Rate for Payer: Zelis Auto |
$575.20
|
| Rate for Payer: Zelis Worker's Compensation |
$392.57
|
|
|
REPR ELBW MED LIGMNT W/TISSU
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 24345
|
| Hospital Charge Code |
6124345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.21 |
| 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 Community HMO |
$859.80
|
| 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: Cash Price |
$859.80
|
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cigna Commercial |
$1,218.05
|
| Rate for Payer: First Health Commercial |
$1,289.70
|
| Rate for Payer: First Health Workers Compensation |
$553.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,289.70
|
| Rate for Payer: GEHA Commercial |
$1,146.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,289.70
|
| 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: Multiplan All |
$1,304.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,289.70
|
| 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 Commercial |
$1,361.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.75
|
| 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: United Payors & United Providers UP&UP |
$1,332.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$573.20
|
| 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 |
$391.21
|
|
|
REPR ELBW MED LIGMNT W/TISSU
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 24345
|
| Hospital Charge Code |
6124345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$1,361.35 |
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cigna Commercial |
$1,218.05
|
| Rate for Payer: First Health Commercial |
$1,289.70
|
| Rate for Payer: First Health Workers Compensation |
$553.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,289.70
|
| Rate for Payer: GEHA Commercial |
$1,003.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,289.70
|
| Rate for Payer: Multiplan All |
$1,304.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,289.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,361.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,332.69
|
| Rate for Payer: Zelis Auto |
$573.20
|
| Rate for Payer: Zelis Worker's Compensation |
$391.21
|
|
