|
REPR OF ANAL FISTULA W/GLUE
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
6146706
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$306.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$434.35
|
| Rate for Payer: First Health Commercial |
$459.90
|
| Rate for Payer: First Health Workers Compensation |
$197.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.90
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.90
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$465.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$357.70
|
| Rate for Payer: One Health Plan PPO/POS |
$459.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$485.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$383.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$475.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$204.40
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$139.50
|
|
|
REPR OF ANAL FISTULA W/GLUE
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
6146706
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$485.45 |
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$434.35
|
| Rate for Payer: First Health Commercial |
$459.90
|
| Rate for Payer: First Health Workers Compensation |
$197.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.90
|
| Rate for Payer: GEHA Commercial |
$357.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.90
|
| Rate for Payer: Multiplan All |
$465.01
|
| Rate for Payer: OMNI Networks Commercial |
$357.70
|
| Rate for Payer: One Health Plan PPO/POS |
$459.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$485.45
|
| Rate for Payer: Three Rivers Provider Network All |
$383.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$475.23
|
| Rate for Payer: Zelis Auto |
$204.40
|
| Rate for Payer: Zelis Worker's Compensation |
$139.50
|
|
|
REPR PER/VAG POUCH DBL PROC
|
Facility
|
OP
|
$4,452.00
|
|
|
Service Code
|
CPT 46712
|
| Hospital Charge Code |
6146712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$4,229.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,671.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cigna Commercial |
$3,784.20
|
| Rate for Payer: First Health Commercial |
$4,006.80
|
| Rate for Payer: First Health Workers Compensation |
$1,718.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,006.80
|
| Rate for Payer: GEHA Commercial |
$3,561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,006.80
|
| Rate for Payer: Humana ChoiceCare |
$1,157.52
|
| Rate for Payer: Multiplan All |
$4,051.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,671.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,116.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,006.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,229.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,917.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,140.36
|
| Rate for Payer: Zelis Auto |
$1,780.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,226.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,215.40
|
|
|
REPR PER/VAG POUCH DBL PROC
|
Facility
|
IP
|
$4,452.00
|
|
|
Service Code
|
CPT 46712
|
| Hospital Charge Code |
6146712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,215.40 |
| Max. Negotiated Rate |
$4,229.40 |
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cigna Commercial |
$3,784.20
|
| Rate for Payer: First Health Commercial |
$4,006.80
|
| Rate for Payer: First Health Workers Compensation |
$1,718.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,006.80
|
| Rate for Payer: GEHA Commercial |
$3,116.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,006.80
|
| Rate for Payer: Multiplan All |
$4,051.32
|
| Rate for Payer: OMNI Networks Commercial |
$3,116.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,006.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,229.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,140.36
|
| Rate for Payer: Zelis Auto |
$1,780.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,215.40
|
|
|
REPR PER/VAG POUCH SNGL PROC
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT 46710
|
| Hospital Charge Code |
6146710
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$594.59 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna Commercial |
$1,851.30
|
| Rate for Payer: First Health Commercial |
$1,960.20
|
| Rate for Payer: First Health Workers Compensation |
$840.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,960.20
|
| Rate for Payer: GEHA Commercial |
$1,524.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,960.20
|
| Rate for Payer: Multiplan All |
$1,981.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,524.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,960.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,069.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,633.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,025.54
|
| Rate for Payer: Zelis Auto |
$871.20
|
| Rate for Payer: Zelis Worker's Compensation |
$594.59
|
|
|
REPR PER/VAG POUCH SNGL PROC
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT 46710
|
| Hospital Charge Code |
6146710
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$544.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna Commercial |
$1,851.30
|
| Rate for Payer: First Health Commercial |
$1,960.20
|
| Rate for Payer: First Health Workers Compensation |
$840.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,960.20
|
| Rate for Payer: GEHA Commercial |
$1,742.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,960.20
|
| Rate for Payer: Humana ChoiceCare |
$566.28
|
| Rate for Payer: Multiplan All |
$1,981.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,306.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,524.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,960.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,069.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,633.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,916.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$544.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,025.54
|
| Rate for Payer: Zelis Auto |
$871.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,089.00
|
| Rate for Payer: Zelis Worker's Compensation |
$594.59
|
|
|
REREPAIR FEM HERNIA, BLOCKED
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT 49557
|
| Hospital Charge Code |
6149557
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.14 |
| 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 |
$910.20
|
| 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 |
$910.20
|
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Cigna Commercial |
$1,289.45
|
| Rate for Payer: First Health Commercial |
$1,365.30
|
| Rate for Payer: First Health Workers Compensation |
$585.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,365.30
|
| Rate for Payer: GEHA Commercial |
$1,213.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,365.30
|
| 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 |
$1,380.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,061.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,365.30
|
| 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 |
$1,441.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,137.75
|
| 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 |
$1,410.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$606.80
|
| 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 |
$414.14
|
|
|
REREPAIR FEM HERNIA, BLOCKED
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT 49557
|
| Hospital Charge Code |
6149557
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.14 |
| Max. Negotiated Rate |
$1,441.15 |
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Cigna Commercial |
$1,289.45
|
| Rate for Payer: First Health Commercial |
$1,365.30
|
| Rate for Payer: First Health Workers Compensation |
$585.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,365.30
|
| Rate for Payer: GEHA Commercial |
$1,061.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,365.30
|
| Rate for Payer: Multiplan All |
$1,380.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,061.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,365.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,441.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,137.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,410.81
|
| Rate for Payer: Zelis Auto |
$606.80
|
| Rate for Payer: Zelis Worker's Compensation |
$414.14
|
|
|
REREPAIR FEM HERNIA, REDUCE
|
Facility
|
OP
|
$1,252.00
|
|
|
Service Code
|
CPT 49555
|
| Hospital Charge Code |
6149555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$341.80 |
| 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 |
$751.20
|
| 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 |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$1,064.20
|
| Rate for Payer: First Health Commercial |
$1,126.80
|
| Rate for Payer: First Health Workers Compensation |
$483.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,126.80
|
| Rate for Payer: GEHA Commercial |
$1,001.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,126.80
|
| 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 |
$1,139.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$876.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,126.80
|
| 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 |
$1,189.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$939.00
|
| 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 |
$1,164.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$500.80
|
| 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 |
$341.80
|
|
|
REREPAIR FEM HERNIA, REDUCE
|
Facility
|
IP
|
$1,252.00
|
|
|
Service Code
|
CPT 49555
|
| Hospital Charge Code |
6149555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$341.80 |
| Max. Negotiated Rate |
$1,189.40 |
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$1,064.20
|
| Rate for Payer: First Health Commercial |
$1,126.80
|
| Rate for Payer: First Health Workers Compensation |
$483.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,126.80
|
| Rate for Payer: GEHA Commercial |
$876.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,126.80
|
| Rate for Payer: Multiplan All |
$1,139.32
|
| Rate for Payer: OMNI Networks Commercial |
$876.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,126.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,189.40
|
| Rate for Payer: Three Rivers Provider Network All |
$939.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,164.36
|
| Rate for Payer: Zelis Auto |
$500.80
|
| Rate for Payer: Zelis Worker's Compensation |
$341.80
|
|
|
REREPAIR ING HERNIA, BLOCKED
|
Facility
|
OP
|
$2,296.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
6149521
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$11,849.78 |
| 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 |
$1,377.60
|
| 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 |
$5,924.89
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$1,951.60
|
| Rate for Payer: First Health Commercial |
$2,066.40
|
| Rate for Payer: First Health Workers Compensation |
$886.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,066.40
|
| Rate for Payer: GEHA Commercial |
$1,836.80
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,066.40
|
| Rate for Payer: Humana ChoiceCare |
$6,517.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,924.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,953.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,924.89
|
| Rate for Payer: Multiplan All |
$2,089.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,066.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,181.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,924.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,135.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Auto |
$918.40
|
| Rate for Payer: Zelis Medicare |
$5,036.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,109.87
|
| Rate for Payer: Zelis Worker's Compensation |
$626.81
|
|
|
REREPAIR ING HERNIA, BLOCKED
|
Facility
|
IP
|
$2,296.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
6149521
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$2,181.20 |
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$1,951.60
|
| Rate for Payer: First Health Commercial |
$2,066.40
|
| Rate for Payer: First Health Workers Compensation |
$886.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,066.40
|
| Rate for Payer: GEHA Commercial |
$1,607.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,066.40
|
| Rate for Payer: Multiplan All |
$2,089.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,066.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,181.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,135.28
|
| Rate for Payer: Zelis Auto |
$918.40
|
| Rate for Payer: Zelis Worker's Compensation |
$626.81
|
|
|
REREPAIR ING HERNIA, REDUCE
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
6149520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$552.01 |
| 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 |
$1,213.20
|
| 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 |
$1,213.20
|
| Rate for Payer: Cash Price |
$1,213.20
|
| Rate for Payer: Cigna Commercial |
$1,718.70
|
| Rate for Payer: First Health Commercial |
$1,819.80
|
| Rate for Payer: First Health Workers Compensation |
$780.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,819.80
|
| Rate for Payer: GEHA Commercial |
$1,617.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,819.80
|
| 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 |
$1,840.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,415.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,819.80
|
| 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 |
$1,920.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,516.50
|
| 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 |
$1,880.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$808.80
|
| 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 |
$552.01
|
|
|
REREPAIR ING HERNIA, REDUCE
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
6149520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$552.01 |
| Max. Negotiated Rate |
$1,920.90 |
| Rate for Payer: Cash Price |
$1,213.20
|
| Rate for Payer: Cigna Commercial |
$1,718.70
|
| Rate for Payer: First Health Commercial |
$1,819.80
|
| Rate for Payer: First Health Workers Compensation |
$780.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,819.80
|
| Rate for Payer: GEHA Commercial |
$1,415.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,819.80
|
| Rate for Payer: Multiplan All |
$1,840.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,415.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,819.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,920.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,516.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,880.46
|
| Rate for Payer: Zelis Auto |
$808.80
|
| Rate for Payer: Zelis Worker's Compensation |
$552.01
|
|
|
REREPAIR VENTRL HERN, BLOCK
|
Facility
|
IP
|
$3,012.00
|
|
|
Service Code
|
CPT 49566
|
| Hospital Charge Code |
6149566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.28 |
| Max. Negotiated Rate |
$2,861.40 |
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cigna Commercial |
$2,560.20
|
| Rate for Payer: First Health Commercial |
$2,710.80
|
| Rate for Payer: First Health Workers Compensation |
$1,162.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,710.80
|
| Rate for Payer: GEHA Commercial |
$2,108.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,710.80
|
| Rate for Payer: Multiplan All |
$2,740.92
|
| Rate for Payer: OMNI Networks Commercial |
$2,108.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,710.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,861.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,259.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,801.16
|
| Rate for Payer: Zelis Auto |
$1,204.80
|
| Rate for Payer: Zelis Worker's Compensation |
$822.28
|
|
|
REREPAIR VENTRL HERN, BLOCK
|
Facility
|
OP
|
$3,012.00
|
|
|
Service Code
|
CPT 49566
|
| Hospital Charge Code |
6149566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$753.00 |
| Max. Negotiated Rate |
$2,861.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cigna Commercial |
$2,560.20
|
| Rate for Payer: First Health Commercial |
$2,710.80
|
| Rate for Payer: First Health Workers Compensation |
$1,162.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,710.80
|
| Rate for Payer: GEHA Commercial |
$2,409.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,710.80
|
| Rate for Payer: Humana ChoiceCare |
$783.12
|
| Rate for Payer: Multiplan All |
$2,740.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,807.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,108.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,710.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,861.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,259.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,650.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$753.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,801.16
|
| Rate for Payer: Zelis Auto |
$1,204.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,506.00
|
| Rate for Payer: Zelis Worker's Compensation |
$822.28
|
|
|
REREPAIR VENTRL HERN, REDUCE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 49565
|
| Hospital Charge Code |
6149565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.75 |
| Max. Negotiated Rate |
$2,336.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,475.40
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$2,090.15
|
| Rate for Payer: First Health Commercial |
$2,213.10
|
| Rate for Payer: First Health Workers Compensation |
$949.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,213.10
|
| Rate for Payer: GEHA Commercial |
$1,967.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,213.10
|
| Rate for Payer: Humana ChoiceCare |
$639.34
|
| Rate for Payer: Multiplan All |
$2,237.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,475.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,721.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,213.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,336.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,844.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,163.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,286.87
|
| Rate for Payer: Zelis Auto |
$983.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,229.50
|
| Rate for Payer: Zelis Worker's Compensation |
$671.31
|
|
|
REREPAIR VENTRL HERN, REDUCE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 49565
|
| Hospital Charge Code |
6149565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$671.31 |
| Max. Negotiated Rate |
$2,336.05 |
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$2,090.15
|
| Rate for Payer: First Health Commercial |
$2,213.10
|
| Rate for Payer: First Health Workers Compensation |
$949.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,213.10
|
| Rate for Payer: GEHA Commercial |
$1,721.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,213.10
|
| Rate for Payer: Multiplan All |
$2,237.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,721.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,213.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,336.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,844.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,286.87
|
| Rate for Payer: Zelis Auto |
$983.60
|
| Rate for Payer: Zelis Worker's Compensation |
$671.31
|
|
|
RESECT ABD TUM < 5 CM
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 22904
|
| Hospital Charge Code |
6122904
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.05 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,312.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna Commercial |
$1,858.95
|
| Rate for Payer: First Health Commercial |
$1,968.30
|
| Rate for Payer: First Health Workers Compensation |
$844.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,968.30
|
| Rate for Payer: GEHA Commercial |
$1,749.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,968.30
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,990.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,530.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,968.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,077.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,640.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,033.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$874.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$597.05
|
|
|
RESECT ABD TUM < 5 CM
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 22904
|
| Hospital Charge Code |
6122904
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.05 |
| Max. Negotiated Rate |
$2,077.65 |
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna Commercial |
$1,858.95
|
| Rate for Payer: First Health Commercial |
$1,968.30
|
| Rate for Payer: First Health Workers Compensation |
$844.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,968.30
|
| Rate for Payer: GEHA Commercial |
$1,530.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,968.30
|
| Rate for Payer: Multiplan All |
$1,990.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,530.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,968.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,077.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,640.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,033.91
|
| Rate for Payer: Zelis Auto |
$874.80
|
| Rate for Payer: Zelis Worker's Compensation |
$597.05
|
|
|
RESECT ABD TUM 5 CM/>
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
CPT 22905
|
| Hospital Charge Code |
6122905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$758.67 |
| Max. Negotiated Rate |
$2,640.05 |
| Rate for Payer: Cash Price |
$1,667.40
|
| Rate for Payer: Cigna Commercial |
$2,362.15
|
| Rate for Payer: First Health Commercial |
$2,501.10
|
| Rate for Payer: First Health Workers Compensation |
$1,072.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,501.10
|
| Rate for Payer: GEHA Commercial |
$1,945.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,501.10
|
| Rate for Payer: Multiplan All |
$2,528.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,945.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,501.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,640.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,084.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,584.47
|
| Rate for Payer: Zelis Auto |
$1,111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$758.67
|
|
|
RESECT ABD TUM 5 CM/>
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
CPT 22905
|
| Hospital Charge Code |
6122905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$758.67 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,667.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,667.40
|
| Rate for Payer: Cash Price |
$1,667.40
|
| Rate for Payer: Cigna Commercial |
$2,362.15
|
| Rate for Payer: First Health Commercial |
$2,501.10
|
| Rate for Payer: First Health Workers Compensation |
$1,072.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,501.10
|
| Rate for Payer: GEHA Commercial |
$2,223.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,501.10
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$2,528.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,945.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,501.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,640.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,084.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,584.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$1,111.60
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$758.67
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Facility
|
IP
|
$2,148.00
|
|
|
Service Code
|
CPT 24077
|
| Hospital Charge Code |
6124077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,503.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Facility
|
OP
|
$2,148.00
|
|
|
Service Code
|
CPT 24077
|
| Hospital Charge Code |
6124077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,718.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 24079
|
| Hospital Charge Code |
6124079
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$750.20 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,648.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Cigna Commercial |
$2,335.80
|
| Rate for Payer: First Health Commercial |
$2,473.20
|
| Rate for Payer: First Health Workers Compensation |
$1,061.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,473.20
|
| Rate for Payer: GEHA Commercial |
$2,198.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,473.20
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$2,500.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,923.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,473.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,610.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,061.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,555.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$1,099.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$750.20
|
|
