|
REVISE MIDDLE EAR BONE
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 69661
|
| Hospital Charge Code |
6169661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$2,723.00
|
|
|
Service Code
|
CPT 69642
|
| Hospital Charge Code |
6169642
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$743.38 |
| Max. Negotiated Rate |
$2,586.85 |
| Rate for Payer: Cash Price |
$1,633.80
|
| Rate for Payer: Cigna Commercial |
$2,314.55
|
| Rate for Payer: First Health Commercial |
$2,450.70
|
| Rate for Payer: First Health Workers Compensation |
$1,051.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,450.70
|
| Rate for Payer: GEHA Commercial |
$1,906.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,450.70
|
| Rate for Payer: Multiplan All |
$2,477.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,450.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,586.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,042.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,532.39
|
| Rate for Payer: Zelis Auto |
$1,089.20
|
| Rate for Payer: Zelis Worker's Compensation |
$743.38
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$3,137.00
|
|
|
Service Code
|
CPT 69646
|
| Hospital Charge Code |
6169646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$856.40 |
| Max. Negotiated Rate |
$2,980.15 |
| Rate for Payer: Cash Price |
$1,882.20
|
| Rate for Payer: Cigna Commercial |
$2,666.45
|
| Rate for Payer: First Health Commercial |
$2,823.30
|
| Rate for Payer: First Health Workers Compensation |
$1,211.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,823.30
|
| Rate for Payer: GEHA Commercial |
$2,195.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,823.30
|
| Rate for Payer: Multiplan All |
$2,854.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,823.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,980.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,917.41
|
| Rate for Payer: Zelis Auto |
$1,254.80
|
| Rate for Payer: Zelis Worker's Compensation |
$856.40
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$2,119.00
|
|
|
Service Code
|
CPT 69641
|
| Hospital Charge Code |
6169641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$578.49 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$1,801.15
|
| Rate for Payer: First Health Commercial |
$1,907.10
|
| Rate for Payer: First Health Workers Compensation |
$818.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,907.10
|
| Rate for Payer: GEHA Commercial |
$1,483.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,907.10
|
| Rate for Payer: Multiplan All |
$1,928.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,483.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,907.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,013.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,589.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,970.67
|
| Rate for Payer: Zelis Auto |
$847.60
|
| Rate for Payer: Zelis Worker's Compensation |
$578.49
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$2,723.00
|
|
|
Service Code
|
CPT 69642
|
| Hospital Charge Code |
6169642
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$743.38 |
| 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 |
$1,633.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,633.80
|
| Rate for Payer: Cash Price |
$1,633.80
|
| Rate for Payer: Cigna Commercial |
$2,314.55
|
| Rate for Payer: First Health Commercial |
$2,450.70
|
| Rate for Payer: First Health Workers Compensation |
$1,051.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,450.70
|
| Rate for Payer: GEHA Commercial |
$2,178.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,450.70
|
| 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 |
$2,477.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,450.70
|
| 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 |
$2,586.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,042.25
|
| 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 |
$2,532.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,089.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$743.38
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 69643
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.41 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna Commercial |
$2,121.60
|
| Rate for Payer: First Health Commercial |
$2,246.40
|
| Rate for Payer: First Health Workers Compensation |
$963.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,246.40
|
| Rate for Payer: GEHA Commercial |
$1,747.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,246.40
|
| Rate for Payer: Multiplan All |
$2,271.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,321.28
|
| Rate for Payer: Zelis Auto |
$998.40
|
| Rate for Payer: Zelis Worker's Compensation |
$681.41
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
CPT 69643
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.41 |
| 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 |
$1,497.60
|
| 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 |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna Commercial |
$2,121.60
|
| Rate for Payer: First Health Commercial |
$2,246.40
|
| Rate for Payer: First Health Workers Compensation |
$963.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,246.40
|
| Rate for Payer: GEHA Commercial |
$1,996.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,246.40
|
| 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 |
$2,271.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,246.40
|
| 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 |
$2,371.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.00
|
| 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 |
$2,321.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$998.40
|
| 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 |
$681.41
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT 69645
|
| Hospital Charge Code |
6169645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$805.08 |
| Max. Negotiated Rate |
$2,801.55 |
| Rate for Payer: Cash Price |
$1,769.40
|
| Rate for Payer: Cigna Commercial |
$2,506.65
|
| Rate for Payer: First Health Commercial |
$2,654.10
|
| Rate for Payer: First Health Workers Compensation |
$1,138.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,654.10
|
| Rate for Payer: GEHA Commercial |
$2,064.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,654.10
|
| Rate for Payer: Multiplan All |
$2,683.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,064.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,654.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,801.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,211.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,742.57
|
| Rate for Payer: Zelis Auto |
$1,179.60
|
| Rate for Payer: Zelis Worker's Compensation |
$805.08
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$2,119.00
|
|
|
Service Code
|
CPT 69641
|
| Hospital Charge Code |
6169641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$578.49 |
| 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 |
$1,271.40
|
| 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 |
$1,271.40
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$1,801.15
|
| Rate for Payer: First Health Commercial |
$1,907.10
|
| Rate for Payer: First Health Workers Compensation |
$818.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,907.10
|
| Rate for Payer: GEHA Commercial |
$1,695.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,907.10
|
| 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 |
$1,928.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,483.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,907.10
|
| 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 |
$2,013.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,589.25
|
| 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 |
$1,970.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$847.60
|
| 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 |
$578.49
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$2,999.00
|
|
|
Service Code
|
CPT 69644
|
| Hospital Charge Code |
6169644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$818.73 |
| 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 |
$1,799.40
|
| 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 |
$1,799.40
|
| Rate for Payer: Cash Price |
$1,799.40
|
| Rate for Payer: Cigna Commercial |
$2,549.15
|
| Rate for Payer: First Health Commercial |
$2,699.10
|
| Rate for Payer: First Health Workers Compensation |
$1,157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,699.10
|
| Rate for Payer: GEHA Commercial |
$2,399.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,699.10
|
| 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 |
$2,729.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,099.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,699.10
|
| 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 |
$2,849.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,249.25
|
| 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 |
$2,789.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,199.60
|
| 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 |
$818.73
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$2,999.00
|
|
|
Service Code
|
CPT 69644
|
| Hospital Charge Code |
6169644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$818.73 |
| Max. Negotiated Rate |
$2,849.05 |
| Rate for Payer: Cash Price |
$1,799.40
|
| Rate for Payer: Cigna Commercial |
$2,549.15
|
| Rate for Payer: First Health Commercial |
$2,699.10
|
| Rate for Payer: First Health Workers Compensation |
$1,157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,699.10
|
| Rate for Payer: GEHA Commercial |
$2,099.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,699.10
|
| Rate for Payer: Multiplan All |
$2,729.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,099.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,699.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,849.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,789.07
|
| Rate for Payer: Zelis Auto |
$1,199.60
|
| Rate for Payer: Zelis Worker's Compensation |
$818.73
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$3,137.00
|
|
|
Service Code
|
CPT 69646
|
| Hospital Charge Code |
6169646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$856.40 |
| 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 |
$1,882.20
|
| 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 |
$1,882.20
|
| Rate for Payer: Cash Price |
$1,882.20
|
| Rate for Payer: Cigna Commercial |
$2,666.45
|
| Rate for Payer: First Health Commercial |
$2,823.30
|
| Rate for Payer: First Health Workers Compensation |
$1,211.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,823.30
|
| Rate for Payer: GEHA Commercial |
$2,509.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,823.30
|
| 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 |
$2,854.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,823.30
|
| 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 |
$2,980.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.75
|
| 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 |
$2,917.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,254.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$856.40
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT 69645
|
| Hospital Charge Code |
6169645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$805.08 |
| 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 |
$1,769.40
|
| 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 |
$1,769.40
|
| Rate for Payer: Cash Price |
$1,769.40
|
| Rate for Payer: Cigna Commercial |
$2,506.65
|
| Rate for Payer: First Health Commercial |
$2,654.10
|
| Rate for Payer: First Health Workers Compensation |
$1,138.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,654.10
|
| Rate for Payer: GEHA Commercial |
$2,359.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,654.10
|
| 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 |
$2,683.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,064.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,654.10
|
| 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 |
$2,801.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,211.75
|
| 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 |
$2,742.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,179.60
|
| 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 |
$805.08
|
|
|
REVISE PALSY HAND TENDON(S)
|
Facility
|
IP
|
$1,879.00
|
|
|
Service Code
|
CPT 25316
|
| Hospital Charge Code |
6125316
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.97 |
| Max. Negotiated Rate |
$1,785.05 |
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$1,597.15
|
| Rate for Payer: First Health Commercial |
$1,691.10
|
| Rate for Payer: First Health Workers Compensation |
$725.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,691.10
|
| Rate for Payer: GEHA Commercial |
$1,315.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,691.10
|
| Rate for Payer: Multiplan All |
$1,709.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,315.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,691.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,785.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,409.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.47
|
| Rate for Payer: Zelis Auto |
$751.60
|
| Rate for Payer: Zelis Worker's Compensation |
$512.97
|
|
|
REVISE PALSY HAND TENDON(S)
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 25315
|
| Hospital Charge Code |
6125315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.07 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$947.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cigna Commercial |
$1,342.15
|
| Rate for Payer: First Health Commercial |
$1,421.10
|
| Rate for Payer: First Health Workers Compensation |
$609.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,421.10
|
| Rate for Payer: GEHA Commercial |
$1,263.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,421.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,436.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,105.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,421.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,500.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,184.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,468.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$631.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$431.07
|
|
|
REVISE PALSY HAND TENDON(S)
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 25315
|
| Hospital Charge Code |
6125315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.07 |
| Max. Negotiated Rate |
$1,500.05 |
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cigna Commercial |
$1,342.15
|
| Rate for Payer: First Health Commercial |
$1,421.10
|
| Rate for Payer: First Health Workers Compensation |
$609.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,421.10
|
| Rate for Payer: GEHA Commercial |
$1,105.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,421.10
|
| Rate for Payer: Multiplan All |
$1,436.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,105.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,421.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,500.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,184.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,468.47
|
| Rate for Payer: Zelis Auto |
$631.60
|
| Rate for Payer: Zelis Worker's Compensation |
$431.07
|
|
|
REVISE PALSY HAND TENDON(S)
|
Facility
|
OP
|
$1,879.00
|
|
|
Service Code
|
CPT 25316
|
| Hospital Charge Code |
6125316
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.97 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,127.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$1,597.15
|
| Rate for Payer: First Health Commercial |
$1,691.10
|
| Rate for Payer: First Health Workers Compensation |
$725.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,691.10
|
| Rate for Payer: GEHA Commercial |
$1,503.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,691.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,709.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,315.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,691.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,785.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,409.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$751.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$512.97
|
|
|
REVISE PENIS/URETHRA
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
CPT 54336
|
| Hospital Charge Code |
6154336
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$704.34 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,548.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,193.00
|
| Rate for Payer: First Health Commercial |
$2,322.00
|
| Rate for Payer: First Health Workers Compensation |
$996.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,322.00
|
| Rate for Payer: GEHA Commercial |
$2,064.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,322.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$2,347.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,806.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,322.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,451.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,399.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$1,032.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$704.34
|
|
|
REVISE PENIS/URETHRA
|
Facility
|
OP
|
$2,206.00
|
|
|
Service Code
|
CPT 54332
|
| Hospital Charge Code |
6154332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$602.24 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,323.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,323.60
|
| Rate for Payer: Cash Price |
$1,323.60
|
| Rate for Payer: Cigna Commercial |
$1,875.10
|
| Rate for Payer: First Health Commercial |
$1,985.40
|
| Rate for Payer: First Health Workers Compensation |
$851.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,985.40
|
| Rate for Payer: GEHA Commercial |
$1,764.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,985.40
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$2,007.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,544.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,985.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,095.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,654.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,051.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$882.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$602.24
|
|
|
REVISE PENIS/URETHRA
|
Facility
|
OP
|
$1,938.00
|
|
|
Service Code
|
CPT 54328
|
| Hospital Charge Code |
6154328
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.07 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,162.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,162.80
|
| Rate for Payer: Cash Price |
$1,162.80
|
| Rate for Payer: Cigna Commercial |
$1,647.30
|
| Rate for Payer: First Health Commercial |
$1,744.20
|
| Rate for Payer: First Health Workers Compensation |
$748.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,744.20
|
| Rate for Payer: GEHA Commercial |
$1,550.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,744.20
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,763.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,356.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,744.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,841.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,453.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,802.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$775.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$529.07
|
|
|
REVISE PENIS/URETHRA
|
Facility
|
IP
|
$1,938.00
|
|
|
Service Code
|
CPT 54328
|
| Hospital Charge Code |
6154328
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.07 |
| Max. Negotiated Rate |
$1,841.10 |
| Rate for Payer: Cash Price |
$1,162.80
|
| Rate for Payer: Cigna Commercial |
$1,647.30
|
| Rate for Payer: First Health Commercial |
$1,744.20
|
| Rate for Payer: First Health Workers Compensation |
$748.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,744.20
|
| Rate for Payer: GEHA Commercial |
$1,356.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,744.20
|
| Rate for Payer: Multiplan All |
$1,763.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,356.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,744.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,841.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,453.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,802.34
|
| Rate for Payer: Zelis Auto |
$775.20
|
| Rate for Payer: Zelis Worker's Compensation |
$529.07
|
|
|
REVISE PENIS/URETHRA
|
Facility
|
IP
|
$2,206.00
|
|
|
Service Code
|
CPT 54332
|
| Hospital Charge Code |
6154332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$602.24 |
| Max. Negotiated Rate |
$2,095.70 |
| Rate for Payer: Cash Price |
$1,323.60
|
| Rate for Payer: Cigna Commercial |
$1,875.10
|
| Rate for Payer: First Health Commercial |
$1,985.40
|
| Rate for Payer: First Health Workers Compensation |
$851.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,985.40
|
| Rate for Payer: GEHA Commercial |
$1,544.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,985.40
|
| Rate for Payer: Multiplan All |
$2,007.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,544.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,985.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,095.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,654.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,051.58
|
| Rate for Payer: Zelis Auto |
$882.40
|
| Rate for Payer: Zelis Worker's Compensation |
$602.24
|
|
|
REVISE PENIS/URETHRA
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
CPT 54336
|
| Hospital Charge Code |
6154336
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$704.34 |
| Max. Negotiated Rate |
$2,451.00 |
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,193.00
|
| Rate for Payer: First Health Commercial |
$2,322.00
|
| Rate for Payer: First Health Workers Compensation |
$996.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,322.00
|
| Rate for Payer: GEHA Commercial |
$1,806.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,322.00
|
| Rate for Payer: Multiplan All |
$2,347.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,806.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,322.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,451.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,935.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,399.40
|
| Rate for Payer: Zelis Auto |
$1,032.00
|
| Rate for Payer: Zelis Worker's Compensation |
$704.34
|
|
|
REVISE PROSTH VAG GRAFT LAP
|
Facility
|
OP
|
$1,713.00
|
|
|
Service Code
|
CPT 57426
|
| Hospital Charge Code |
6157426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$467.65 |
| Max. Negotiated Rate |
$14,043.34 |
| 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 |
$1,027.80
|
| 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 |
$7,021.67
|
| Rate for Payer: Cash Price |
$1,027.80
|
| Rate for Payer: Cash Price |
$1,027.80
|
| Rate for Payer: Cigna Commercial |
$1,456.05
|
| Rate for Payer: First Health Commercial |
$1,541.70
|
| Rate for Payer: First Health Workers Compensation |
$661.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,541.70
|
| Rate for Payer: GEHA Commercial |
$1,370.40
|
| Rate for Payer: GEHA Medicare |
$7,021.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,541.70
|
| 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 |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,021.67
|
| Rate for Payer: Multiplan All |
$1,558.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,936.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,199.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,541.70
|
| 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 |
$7,021.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,627.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,043.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,284.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,881.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,021.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,593.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,021.67
|
| Rate for Payer: Zelis Auto |
$685.20
|
| 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 |
$467.65
|
|
|
REVISE PROSTH VAG GRAFT LAP
|
Facility
|
IP
|
$1,713.00
|
|
|
Service Code
|
CPT 57426
|
| Hospital Charge Code |
6157426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$467.65 |
| Max. Negotiated Rate |
$1,627.35 |
| Rate for Payer: Cash Price |
$1,027.80
|
| Rate for Payer: Cigna Commercial |
$1,456.05
|
| Rate for Payer: First Health Commercial |
$1,541.70
|
| Rate for Payer: First Health Workers Compensation |
$661.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,541.70
|
| Rate for Payer: GEHA Commercial |
$1,199.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,541.70
|
| Rate for Payer: Multiplan All |
$1,558.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,199.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,541.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,627.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,284.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,593.09
|
| Rate for Payer: Zelis Auto |
$685.20
|
| Rate for Payer: Zelis Worker's Compensation |
$467.65
|
|
